Real-world evidence for herbal medicine benefit in 9728 type 2 diabetes patients-peridonotitis risk and ambulatory care utilization

doi:10.4239/wjd.v16.i11.112171

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 11

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (0)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-3)

Tables (1-4)

Sum=0

Nov 15, 2025 (publication date) through Nov 14, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Diabetes

ISSN

1948-9358

Publisher of This Article

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

Retrospective Cohort Study

World J Diabetes. Nov 15, 2025; 16(11): 112171
Published online Nov 15, 2025. doi: 10.4239/wjd.v16.i11.112171

Real-world evidence for herbal medicine benefit in 9728 type 2 diabetes patients-peridonotitis risk and ambulatory care utilization

Wen-Wei Lin, Chieh-Tsung Yen, Hanoch Livneh, Hua-Lung Huang, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Wen-Wei Lin, Wei-Jen Chen, Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 333325, Taiwan

Chieh-Tsung Yen, Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

Hanoch Livneh, Rehabilitation Counseling Program, 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

Ming-Chi Lu, School of Medicine, Tzu Chi University, Hualien 97050, Taiwan

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

Wei-Jen Chen, School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97050, Taiwan

Wei-Jen Chen, Center of Sports Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan

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

Tzung-Yi Tsai, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan

Co-corresponding authors: Wei-Jen Chen and Tzung-Yi Tsai.

Author contributions: Lin WW, Livneh H, Yen CT, and Tsai TY were involved in the study design and drafted the manuscript; Huang HL, Chen WJ and Tsai TY contributed to data analysis and revised the manuscript; Lin WW, Livneh H, Yen CT, Huang HL, Chen WJ and Tsai TY contributed to the interpretation of data and provided comments on the final draft of the manuscript; Lu MC provided administrative support along with revision of the study; all authors gave final approval to the version to be published and agree to be accountable for all aspects of the work; Lin WW, Huang HL and Yen CT contributed equally to this work; Chen WJ and Tsai TY contributed equally to this work as co-corresponding authors.

Institutional review board statement: Given the anonymization of all personal identifiers in the database, the Institutional Review Board of Buddhist Dalin Tzu Chi Hospital confirmed that this study met the exemption criteria for full review (No. B10802014). This study was also conducted in accordance with the guidelines of the Helsinki Declaration.

Informed consent statement: As all analytical data used in this work were anonymized, the Institutional Review Board of Buddhist Dalin Tzu Chi Hospital confirmed that this study was exempt from full review along with the need for informed consent in this study.

Conflict-of-interest statement: The author(s) report no conflicts of interest in this work.

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.

Data sharing statement: Due to legal restrictions imposed by the government of Taiwan in relation to the “Personal Information Protection Act”, data cannot be made publicly available. Requests to access the datasets should be directed to the NHI administration and the corresponding authors.

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: Tzung-Yi Tsai, PhD, Assistant Professor, 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: July 21, 2025
Revised: September 10, 2025
Accepted: October 20, 2025
Published online: November 15, 2025
Processing time: 117 Days and 23.2 Hours

Abstract

BACKGROUND

Recent evidence manifests that individuals with type 2 diabetes (T2D) are increasingly affected by oral disorders. Although medicinal herbs have shown promise in managing T2D, their benefit in managing periodontitis risk and subsequent healthcare utilization remains uncertain.

AIM

To compare risk of periodontitis and associated ambulatory care utilization among individuals with T2D who did or did not receive add-on medicinal herbs.

METHODS

We included individuals aged 20-70 years with newly diagnosis of T2D and being free of periodontitis in 2000 and 2010. Periodontitis events were tracked from cohort entry until December 31, 2013. The association between medicinal herb use and periodontitis risk was assessed by multivariate Cox regression, while differences in periodontitis-related ambulatory care were analyzed using Mann-Whitney U test.

RESULTS

After propensity score matching, 9728 individuals were included in both the herbal and non-herbal groups. Those who used herbs for more than two years experienced a potently lower risk of periodontitis by 52%. Compared to herb users, the non-users substantially incurred higher frequency and cost of periodontitis-related ambulatory visits post-diagnosis, and the costs per ambulatory visit increased with time after periodontitis onset.

CONCLUSION

The rollout of this study not only tackled the former research gap but also provided an insight that the combination of medicinal herbs may take into account while planning holistic and individualized oral health care for T2D persons.

Keywords: Type 2 diabetes; Periodontitis; Medicinal herbs; Cohort study; Interdisciplinary collaboration; Risk

Core Tip: As periodontitis is a common and frequently occurring condition following type 2 diabetes (T2D) onset and insidiously triples cardiorenal mortality in individuals with diabetes, we conducted a population-based cohort study to gain deeper insight into the relationship between medicinal herb use and incident periodontitis. In this study, adding medicinal herbs to routine care for more than 2 years benefited T2D individuals by lowering periodontitis risk as much as 52%; moreover, this approach substantially reduced the subsequent use of periodontitis-related ambulatory services, underscoring the increasing importance of interdisciplinary healthcare.