Chinese herbal medicine for the treatment of people with impaired glucose tolerance and insulin resistance

This research was undertaken to investigate Chinese herbal medicine for the treatment of impaired glucose tolerance and insulin resistance. The prevalence of diabetes is a rapidly growing with considerable social and economic costs to our community. It is desirable that progress from prediabetes to frank diabetes be stopped or delayed. There has been considerable research undertaken in lifestyle and pharmaceutical prevention or delay or diabetes but there is no cure, pharmaceutical interventions often have side effects and lifestyle interventions are not always achieveable. There have been a number of clinical trials of Chinese herbal medicine interventions in recent years but there has been no review undertaken of Chinese herbal medicine interventions. The objective of this research was to review the evidence for the treatment of prediabetes with traditional Chinese herbal medicine and examines the traditional Chinese medicine approach to the treatment of prediabetes. This involved two main pieces of research a systematic review to evaluate the efficacy and safety of Chinese herbal medicine for the treatment of impaired glucose tolerance or impaired fasting blood glucose; and a double blinded, randomised and placebo-controlled clinical trial to evaluate the effectiveness of a Chinese herbal formula, Jiangtang Xiaozhi for the treatment of impaired glucose tolerance and insulin resistance in persons with prediabetes and mild diabetes. In the preparation for the conduct of the clinical trial and systematic review an examination of the traditional Chinese medicine (TCM) patterns of disharmony and treatment principles was undertaken. An inter-rater reliability study of the TCM diagnosis of people with prediabetes using a subset of the clinical trial participants was also conducted. The findings of our inter-rater reliability study indicated that TCM practitioners diagnosing patients with prediabetes commonly selected one of three patterns: Qi and Yin deficiency, Spleen qi deficiency or Yin deficiency. There was a moderate level of inter-rater reliability between practitioners. The methodology of inter-rater reliability studies of TCM diagnosis would benefit from further refinement, building on research that has already been conducted. The continued improvement of the face and content validity of the TEAMSI-TCM instrument will result in a robust tool for the conduct of clinical trials