The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical, psychosocial, and behavioral outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis

Abstract

BACKGROUND: Integrative diabetes care, which combines conventional diabetes therapy with traditional Chinese medicine (TCM)-based interventions, has gained popularity worldwide. Numerous TCM-based lifestyle modification approaches have been proposed for individuals with type 2 diabetes (T2DM).
OBJECTIVES: To synthesize and present the best available evidence on the effectiveness of TCM-based lifestyle interventions in individuals with T2DM.
DESIGN: We undertook a systematic review of randomized controlled trials or controlled clinical trials.
DATA SOURCES: Six English and four Chinese electronic databases were searched from their inceptions to December 2016.
REVIEW METHODS: Trials investigating the effectiveness of various TCM-based lifestyle interventions among adults with T2DM were reviewed. Studies were excluded if TCM-based lifestyle interventions were only part of the intervention regimen. Two reviewers independently selected studies according to pre-specified inclusion and exclusion criteria and appraised the risk of bias of the included studies. One reviewer extracted details of the included studies and the second reviewer checked the extracted data critically. When feasible, data were statistically pooled for meta-analysis. Otherwise, narrative summaries were used.
RESULTS: Twenty-four studies were included. The pooled analysis of the eight studies on tai chi showed tai chi practice for at least 150min per week was beneficial in lowering glycosylated hemoglobin (mean difference, -1.48%; 95%CI, -2.58% to -0.39%; p<0.001). Tai chi was effective in reducing fasting blood glucose (mean difference, -1.14mmol/L; 95%CI, -1.78 to -0.50mmol/L; p<0.001) and body mass index (mean difference, -0.62; 95%CI, -1.14 to -0.11; p=0.02), and improving quality of life. The effects of tai chi on blood pressure and waist circumference were inconclusive due to the limited number of studies. The meta-analysis of the 12 studies on ba duan jin demonstrated beneficial effects on glycosylated hemoglobin (mean difference, -0.77%; 95%CI, -0.97% to -0.56%; p<0.001), fasting blood glucose (mean difference, -0.82mmol/L; 95%CI, -1.05 to -0.59mmol/L; p<0.001), body mass index (mean difference, -2.77; 95%CI, -4.11 to -1.43; p<0.001), and depression (mean difference, -4.53; 95%CI, -7.12 to -1.94; p<0.001). Conclusions on the effects of ba duan jin on quality of life cannot be drawn because only two studies measured the outcome. Evidence regarding the effectiveness of other TCM-based lifestyle interventions is limited.
CONCLUSIONS: Tai chi and ba duan jin are potentially effective options for individuals with T2DM to improve biomedical and psychosocial well-being. Further well-designed studies are needed to explore the optimal intervention dose and to investigate the effectiveness of other TCM-based lifestyle interventions.