Reduced risk of dementia in patients with type 2 diabetes mellitus using Chinese herbal medicine: A nested case-control study

doi:10.4239/wjd.v14.i11.1632

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Nov 15, 2023; 14(11): 1632-1642
Published online Nov 15, 2023. doi: 10.4239/wjd.v14.i11.1632

Reduced risk of dementia in patients with type 2 diabetes mellitus using Chinese herbal medicine: A nested case-control study

Hou-Hsun Liao, Hanoch Livneh, Hua-Lung Huang, Jui-Yu Hung, Ming-Chi Lu, How-Ran Guo, Tzung-Yi Tsai

Hou-Hsun Liao, Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

Hou-Hsun Liao, Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan

Hou-Hsun Liao, Tzung-Yi Tsai, Department of Nursing, Tzu Chi University of Science and Technology, Hualien 62247, Taiwan

Hanoch Livneh, Department of Special and Counselor Education, Portland State University, Portland, OR 97207, United States

Hua-Lung Huang, Department of Rehabilitation, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

Jui-Yu Hung, Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

Ming-Chi Lu, Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

How-Ran Guo, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan

How-Ran Guo, Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 70428, Taiwan

How-Ran Guo, Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan 70428, Taiwan

Tzung-Yi Tsai, Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

Co-corresponding authors: How-Ran Guo and Tzung-Yi Tsai.

Author contributions: Liao HH, Livneh H, and Huang HL contributed equally to this work. Liao HH, Livneh H, and Huang HL were involved in the study design and drafted the manuscript; Livneh H, Lu MC and Tsai TY contributed to data analysis and revised the manuscript; Liao HH, Livneh H, and Hung JY contributed to the interpretation of data and provided comments on the final draft of the manuscript; Lu MC provided administrative support; Guo HR and Tsai TY were not only involved in design and conduct of the study, but also contributed to the software and validation of data; and all authors gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Institutional review board statement: This work has been approved by the facility’s institutional review board (No. B10004021-3).

Informed consent statement: The institutional review board waived the need for informed consent since the raw data used were on the basis of a retrospective claims data with encrypted attribution.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Corresponding author: Tzung-Yi Tsai, PhD, Assistant Professor, Researcher, Statistician, Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2 Minsheng Road, Chiayi 62247, Taiwan. dm732024@tzuchi.com.tw

Received: August 4, 2023
Peer-review started: August 4, 2023
First decision: August 24, 2023
Revised: September 14, 2023
Accepted: October 25, 2023
Article in press: October 25, 2023
Published online: November 15, 2023
Processing time: 101 Days and 23 Hours

Abstract

BACKGROUND

Dementia is a prevalent condition in type 2 diabetes mellitus (T2DM) patients. While Chinese herbal medicine (CHM) is often employed as complementary therapy for glycemic control, its effect in controlling likelihood of dementia has not yet been fully elucidated.

AIM

To compare the risk of dementia between T2DM patients with and without CHM treatment.

METHODS

We undertook a nested case-control study and obtained data on patients 20-70 years of age who received medical care for T2DM between 2001 and 2010 from the National Health Insurance Research database in Taiwan. Cases, defined as those with dementia that occurred at least one year after the diagnosis of T2DM, were randomly matched to controls without dementia from the study cohort at a 1:1 ratio. We applied conditional logistic regression to explore the associations between CHM treatment and dementia.

RESULTS

A total of 11699 dementia cases were matched to 11699 non-dementia controls. We found that adding CHM to conventional care was related to a lower risk of dementia [adjusted odds ratio (OR) = 0.51], and high-intensity CHM treatment was associated with an adjusted OR of 0.22.

CONCLUSION

This study shows that the cumulative CHM exposure was inversely associated with dementia risk in an exposure-response manner, implying that CHM treatment may be embraced as a disease management approach for diabetic patients to prevent dementia.

Keywords: Type 2 diabetes mellitus; Dementia; Chinese herbal medicine; Nested case-control study; Odds ratio

Core Tip: This population-based nested case-control study is the first to determine if integrating Chinese herbal medicine (CHM) into routine care of type 2 diabetes mellitus (T2DM) could aid in the prevention of subsequent dementia chance. In this report, we found that adding CHM to conventional care may reduce the subsequent risk of dementia for T2DM patients by 49%. Identification of an exposure-response manner, negative correlation between the days of CHM use and risk of dementia herein may further support the therapeutic benefit of CHM.