Systematic Evaluation Of Comprehensive Prevention And Treatment Of Pre-diabetes With Traditional Chinese Medicine And Analysis Of Medication Rules

Purpose:To explore the clinical effect of traditional Chinese medicine on the prevention and treatment of pre-diabetes based on the theory of "treating the disease",to explore the prescription of Chinese medicine prescriptions,to provide a basis for clinical control to delay and truncate to reverse the occurrence and development of pre-diabetes,and to establish scientific and effective diabetes prevention The foundation of the knowledge system.Material and method:Design a reasonable search method according to the purpose of the study,search CNKI,CBM,Wanfang Medical Database,VIP,Pubmed,The Cochrane Library,Embase and other databases.The search time is from January 2010 to October 2019.Use Rev Man5.3,Stata / IC,R language and other software for document quality evaluation and data statistical analysis.The main outcome indicators include the incidence of IGR to NGT reversal and the incidence of IGR to DM conversion;secondary outcome indicators include: FPG,2h PG,Hb A1 c,FINS,HOMA-IR,TG,TC,LDL-C,HDL-C,SBP DBP,BMI,clinical effectiveness and incidence of adverse reactions,etc.Ge MTC software was used to draw a ranking chart of the curative effect,combined with TCMISS to formulate the prescription,statistical analysis of the drug frequency,attributes,drug efficacy and so on.Use Gephi software for visual analysis and display.Results: 1 Meta-analysis results This study strictly implemented the inclusion and exclusion criteria,a total of 61 articles were included,and a total of 7752 subjects were included.Analysis of the incidence of IGR to NGT reversal in 61 articles: [Chi2=80.97,I2=25.9%,RR=1.513,95%CI(1.412,1.621),P<0.00001].61 papers analyzed the incidence of IGR to DM conversion: [Chi2=54.98,I2=0.0%,RR=0.509,95%CI(0.455,0.569),P<0.00001].Comprehensive prevention and treatment of traditional Chinese medicine can effectively promote the recovery of blood glucose in IGR patients,reduce Hb Alc levels,and improve the pre-clinical symptoms of IGR patients: 52 literatures for FPG results analysis,[SMD=-0.770,95%CI(-1.023,-0.517),P<0.00001];51 articles for 2h PG analysis,[SMD=-0.783,95%CI(-0.942,-0.625),P<0.00001];33 articles for Hb A1 c analysis,[SMD=-0.824,95%CI(-1.052,-0.596),P<0.00001].Comprehensive prevention and treatment of traditional Chinese medicine can improve insulin sensitivity and reduce insulin resistance in IGR patients: 30 articles for FINS analysis,[SMD=-0.659,95%CI(-0.846,-0.471),P<0.00001];24 articles The HOMA-IR results were analyzed,[SMD=-0.476,95%CI(-0.543,-0.410),P<0.00001].Comprehensive prevention and treatment of traditional Chinese medicine can improve blood lipids in IGR patients: 28 articles were analyzed for TG results,[SMD=-0.476,95%CI(-0.543,-0.410),P<0.00001];29 articles were analyzed for TC results,SMD=-0.399,95%CI(-0.464,-0.335),P<0.00001];21 articles were analyzed for LDLC results: [SMD=-0.328,95%CI(-0.402,-0.254),P<0.00001];17 articles were analyzed for HDL-C results,[SMD=0.414,95%CI(0.329,0.498),P<0.00001].Comprehensive prevention and treatment of traditional Chinese medicine can improve the blood pressure and weight of IGR patients: 15 articles for SBP analysis,[SMD=-0.117,95%CI(-0.210,-0.024),P=0.013];8 articles for DBP analysis,[SMD=-0.062,95%CI(-0.127,0.003),P=0.840];32 documents for BMI results analysis,[SMD=-0.403,95%CI(-0.467,-0.339),P<0.00001].The comprehensive prevention and treatment of IGR in traditional Chinese medicine regulates human functions as a whole,which is in line with the idea of "treating no disease" in traditional Chinese medicine,and its clinical effectiveness is better than that of the control group: 9 articles for effective results analysis,[Chi2=18.31,I2=56.3%,OR=1.297,95%CI(1.28,1.92),P<0.00001].The comprehensive prevention and treatment of IGR with traditional Chinese medicine has higher clinical safety and better patient compliance.Its safety is comparable to the safety of lifestyle intervention and placebo,and the patient is well tolerated: 15 articles mention the number of cases of adverse reactions With specific adverse reaction symptoms,[Chi2 = 33.70,I2=58.5%,OR=0.561,95%CI(0.384,0.818),P=0.003].2 Net meta Analysis Results In this study,Ge MTC software was used to rank the curative effect of 21 kinds of traditional Chinese medicine treatment methods.The result prompts: "Spleen strengthening +nourishing kidney + supplementing qi + nourishing yin "," spleen strengthening + nourishing qi + clearing heat + activating blood "," tonifying kidney + nourishing yin "," spleen strengthening + phlegm + nourishing qi "," spleen + The five treatment methods of "soothing liver + nourishing kidney + nourishing yin" have the best effect in promoting the reversal of IGR to NGT.3 Analysis results of medication laws T The core medicines for the comprehensive prevention and treatment of IGR with traditional Chinese medicine include astragalus,yam,salvia miltiorrhiza and berberine.The medicinal properties are mostly warm,cold,and flat,and the flavors are more sweet,bitter,and spicy.The spleen meridian is the most,followed by the lung and stomach meridian.Then there are the kidney and liver meridians,which are consistent with the core pathogenesis of "spleen spleen",all have the functions of strengthening the spleen and qi,nourishing yin and clearing heat.Commonly used combinations include "Huanglian-Astragalus","Astragalus-Yam","Danshen-Astragalus","Huanglian-Cangzhu","Astragalus-Atractylodes",etc.The core drugs are Astragalus,Chinese yam,Salvia miltiorrhiza,and Huanglian.The treatment should be based on supplementing qi and spleen,nourishing yin and clearing heat,relieving liver stagnation,promoting blood circulation and removing blood stasis.Conclusion: 1.Comprehensive prevention and treatment of traditional Chinese medicine can significantly increase the incidence of IGR to NGT reversal,significantly reduce the incidence of IGR to DM conversion,stabilize the condition of IGR patients,and prolong the time of DM onset;2.The comprehensive prevention and treatment of traditional Chinese medicine can effectively promote the blood sugar level of IGR patients to return to normal levels,reduce the Hb Alc level of patients,improve the pre-clinical symptoms of IGR patients,increase the insulin sensitivity of IGR patients,and reduce the level of insulin resistance;3.Comprehensive prevention and treatment of traditional Chinese medicine can effectively improve the dyslipidemia,hypertension,obesity and other conditions of IGR patients,reduce the risk factors related to diseases such as vascular complications and metabolic syndrome,and have the effect of preventing the occurrence of DM;4.The comprehensive prevention and treatment of IGR in traditional Chinese medicine should focus on strengthening the spleen and qi,nourishing the kidney and nourishing yin,relieving the liver and regulating qi,precise disease positioning,and applying the idea of "treating the disease" to practice.Among the meridian drugs,the spleen meridian is the most,followed by the lung meridian and the gastric meridian,followed by the kidney meridian and the liver meridian.