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

ARTICLE HIGHLIGHTS

Research background

Over the last several years, patients afflicted with type 2 diabetes mellitus (T2DM) were found to have a nearly double likelihood of having dementia as compared to those without T2DM, which may take a critical toll on their health conditions.

Research motivation

Though the widespread use of Chinese herbal medicine (CHM) in the diabetic patients, to the knowledge of the authors, no population-level study has so far been done to assess if CHM use could be a potential disease management program in lowering risk of dementia among patients with T2DM.

Research objectives

To address this issue, a nested case-control study, aimed to compare dementia risk in T2DM patients with and without the use of CHM, was undertaken.

Research methods

Using a nationwide health insurance database, we identified incident patients diagnosed with T2DM between 2001 and 2010. Among them, each case, defined as who suffered from dementia occurring at least one year after T2DM onset, was randomly matched to one control without dementia. Relationship between CHM use and the risk of dementia was estimated by end of 2013 and evaluated using conditional logistic regression.

Research results

A total of 11699 dementia patients 20-70 years of age, were matched to 11699 non-dementia controls. Among them, use of CHM was correlated to a lower dementia risk (adjusted odds ratio = 0.51, 95% confidence interval: 0.48-0.53). Notably, those receiving high-intensity use of CHM had a 78% reduced the risk of dementia.

Research conclusions

Findings of this study indicated that add-on CHM formulae as part of T2DM care may be a potential treatment in preventing incident dementia.

Research perspectives

A large cohort of diabetic patients created by randomized trials are warranted to further explore the potential mechanisms underlying the clinical benefits of CHM on prevention of cognitive impairment.