Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2023; 14(3): 313-342
Published online Mar 15, 2023. doi: 10.4239/wjd.v14.i3.313
Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis
Yu-Xin Zhang, Yan-Jiao Zhang, Run-Yu Miao, Xin-Yi Fang, Jia-Hua Wei, Yu Wei, Jia-Ran Lin, Jia-Xing Tian
Yu-Xin Zhang, Yan-Jiao Zhang, Run-Yu Miao, Xin-Yi Fang, Yu Wei, Jia-Ran Lin, Jia-Xing Tian, Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Run-Yu Miao, Xin-Yi Fang, Yu Wei, Jia-Ran Lin, Graduate College, Beijing University of Chinese Medicine, Graduate College, Beijing University of Chinese Medicine, Beijing 100029, China
Jia-Hua Wei, Graduate College, Changchun University of Chinese Medicine, Changchun 130117, Jilin Province, China
Author contributions: Zhang YX contributed to conceptualization, software, data curation, writing-Original draft preparation; Tian JX contributed to conceptualization, methodology, funding acquisition; Zhang YJ contributed to data curation, validation; Fang XY contributed to visualization, investigation; Miao RY contributed to software, validation; Wei JH contributed to writing- reviewing and editing; Wei Y contributed to data curation and validation; Lin JR contributed to reviewing and editing.
Supported by CACMS Outstanding Young Scientific and Technological Talents Program, No. ZZ13-YQ-026; Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences, No. CI2021A01601; Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine, No. ZYYCXTD-D-202001; Open Project of National Facility for Translational Medicine, No. TMSK-2021-407; and GAMIMD Special Fund, 2022DXBZX012.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Xing Tian, PhD, Academic Editor, Doctor, Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing 100053, China. tina_yai@126.com
Received: December 2, 2022
Peer-review started: December 2, 2022
First decision: December 19, 2022
Revised: December 29, 2022
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 15, 2023
Processing time: 103 Days and 14.1 Hours
Abstract
BACKGROUND

Diabetic gastroparesis (DGP) is a prevalent complication of diabetes that impairs people's quality of life and places a significant financial burden on them. The gastrointestinal symptoms of DGP patients can be improved by several Traditional Chinese Medicine (TCM) decoctions that have been shown to be effective in treating the disease. There are still many unanswered questions regarding the identification of appropriate therapeutic agents for the treatment of DGP in clinical practice.

AIM

To analyze the efficacy of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis for reference.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, China National Kno-wledge Infrastructure, The China Biology Medicine DVD, Wanfang, and CQVIP were searched from inception to September 17, 2022, to collect randomized controlled trials (RCTs) about TCM decoctions for DGP. Clinical effects and symptom scores were the primary outcomes. Additionally, we assessed motilin (MOT), somatostatin (SS), gastrin (GAS), gastric emptying rate, gastric emptying time, and adverse drug events as secondary outcomes.

RESULTS

A total of 67 eligible RCTs involving 4790 DGP patients and 7 TCM decoctions were included. The results of network meta-analysis (NMA) and surface under the cumulative ranking curve showed that with western medicine (WM) as a common control, the Banxia Xiexin Decoction (BXXD) + WM was most effective in clinical effects and enhancing early satiety scores; the Simo decoction (SMD) + WM was most effective in improving nausea and vomiting scores and anorexia scores, bloating scores; the Chaishao Liujunzi Decoction (CSLJD) was most effective in MOT, the Zhishi Xiaopi Decoction (ZSXPD) was most effective in SS and upgrading emptying rate; the Jianpi Xiaozhi Decoction was most effective in GAS; the CSLJD + WM was most effective in improving gastric emptying time.

CONCLUSION

These NMA results suggest that the BXXD + WM and SMD + WM may be one of the potential optimal treatments. Due to various limitations, further large-sample, double-blind, multi-center randomized RCTs are needed.

Keywords: Diabetic gastroparesis; Traditional Chinese medicine decoction; Network meta-analysis; Effectiveness

Core Tip: The gastrointestinal symptoms of diabetic gastroparesis (DGP) patients can be improved by several Traditional Chinese Medicine (TCM) decoctions that have been shown to be effective in treating the disease. The main objective of this study is to analyze the efficacy and safety of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis(NMA) to better guide clinical decision-making. A total of 67 eligible randomized controlled trials involving 4790 DGP patients and 7 TCM decoctions were included. These NMA results suggest that combined with qualified TCM decoctions, western medicine (WM) is more effective for DGP patients than WM alone.