Fuu-Jen Tsai1, Tsung-Jung Ho2, Chi-Fung Cheng3, Xiang Liu4, Hsinyi Tsang4, Ting-Hsu Lin5, Chiu-Chu Liao5, Shao-Mei Huang5, Ju-Pi Li6, Cheng-Wen Lin7, Jaung-Geng Lin8, Jung-Chun Lin9, Chih-Chien Lin10, Wen-Miin Liang11, Ying-Ju Lin12. 1. School of Chinese Medicine, China Medical University, Taichung, Taiwan; Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Asia University, Taichung, Taiwan. 2. School of Chinese Medicine, China Medical University, Taichung, Taiwan; Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan; Division of Chinese Medicine, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan. 3. Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan. 4. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. 5. Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. 6. School of Chinese Medicine, China Medical University, Taichung, Taiwan; Rheumatism Research Center, China Medical University Hospital, Taichung, Taiwan. 7. Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan. 8. School of Chinese Medicine, China Medical University, Taichung, Taiwan. 9. School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. 10. Department of Cosmetic Science, Providence University, Taichung, Taiwan. 11. Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan. Electronic address: wmliang@mail.cmu.edu.tw. 12. School of Chinese Medicine, China Medical University, Taichung, Taiwan; Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. Electronic address: yjlin.kath@gmail.com.
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Complications of type 2 diabetes (T2D) include stroke, which is a cerebrovascular disturbance characterized by reduced blood flow in the brain, leading to death or physical disability. Chinese herbal medicine (CHM) has been widely used in ancient China for the treatment of diabetes and stroke by supplementing Qi and activating blood circulation. AIM OF THE STUDY: This study aimed to investigate the frequencies and patterns of CHM treatment for stroke patients with T2D and the outcomes of long-term use in Taiwan. MATERIALS AND METHODS: We identified 3079 stroke patients (ICD-9-CM: 430-438) with T2D. We allocated 618 stroke patients, matched for age, gender, and T2D-to-stroke duration, to both CHM and non-CHM groups. Chi-square test, conditional multivariable logistic regression, Kaplan-Meier method, and the log-rank test were used in this study. RESULTS: The CHM group was characterized by more cases of chronic obstructive pulmonary disease, ulcer disease, hyperlipidemia, tobacco use, and higher income. The cumulative survival probability was higher in the CHM group (P<0.001, log rank test); after adjusting for comorbidities, income, and urbanization level, this group also exhibited a lower mortality hazard ratio (0.37, 95% confidence interval [0.25-0.55]). Shu-Jing-Huo-Xue-Tang, Xue-Fu-Zhu-Yu-Tang, and Du-Huo-Ji-Sheng-Tang; and Dan-Shen, Niu-Xi, and Yan-Hu-Suo represented the top three formulas and herbs, respectively. CONCLUSION: The use of CHM as adjunctive therapy may improve the overall survival (OS) of stroke patients with T2D. The list of the comprehensive herbal medicines that they used might be useful in future large-scale, randomized clinical investigations of agent effectiveness, safety, and potential interactions with conventional treatments in stroke patients with T2D.
ETHNOPHARMACOLOGICAL RELEVANCE: Complications of type 2 diabetes (T2D) include stroke, which is a cerebrovascular disturbance characterized by reduced blood flow in the brain, leading to death or physical disability. Chinese herbal medicine (CHM) has been widely used in ancient China for the treatment of diabetes and stroke by supplementing Qi and activating blood circulation. AIM OF THE STUDY: This study aimed to investigate the frequencies and patterns of CHM treatment for strokepatients with T2D and the outcomes of long-term use in Taiwan. MATERIALS AND METHODS: We identified 3079 strokepatients (ICD-9-CM: 430-438) with T2D. We allocated 618 strokepatients, matched for age, gender, and T2D-to-stroke duration, to both CHM and non-CHM groups. Chi-square test, conditional multivariable logistic regression, Kaplan-Meier method, and the log-rank test were used in this study. RESULTS: The CHM group was characterized by more cases of chronic obstructive pulmonary disease, ulcer disease, hyperlipidemia, tobacco use, and higher income. The cumulative survival probability was higher in the CHM group (P<0.001, log rank test); after adjusting for comorbidities, income, and urbanization level, this group also exhibited a lower mortality hazard ratio (0.37, 95% confidence interval [0.25-0.55]). Shu-Jing-Huo-Xue-Tang, Xue-Fu-Zhu-Yu-Tang, and Du-Huo-Ji-Sheng-Tang; and Dan-Shen, Niu-Xi, and Yan-Hu-Suo represented the top three formulas and herbs, respectively. CONCLUSION: The use of CHM as adjunctive therapy may improve the overall survival (OS) of strokepatients with T2D. The list of the comprehensive herbal medicines that they used might be useful in future large-scale, randomized clinical investigations of agent effectiveness, safety, and potential interactions with conventional treatments in strokepatients with T2D.