Association between Albuminuria and Different Body Constitution in Type 2 Diabetes Patients: Taichung Diabetic Body Constitution Study

Associations of traditional Chinese medicine body constitution and all-cause mortality in patients with type 2 diabetes mellitus: a prospective cohort study of a Taiwanese medical center

Introduction

The objective of this study was to investigate associations between baseline body constitutions (BCs) in traditional Chinese Medicine (TCM) and all-cause mortality in Chinese individuals with type 2 diabetes.

Methods

A total of 887 individuals with type 2 diabetes who were enrolled in managed care in 2010 were included. These individuals were followed up until 2015, and their mortality status was determined through the use of Taiwan National Death Datasets. At baseline, BC status of participants, including Yin deficiency, Yang deficiency, and phlegm stasis, was assessed using a well-developed Body Constitutions Questionnaire. Hazard ratios (HR) were calculated using a multivariate Cox proportional hazards model.

Results

During 6807.2 person-years of follow-up of 887 participants, with an average follow-up period of 7.7 years, a total of 190 individuals died, resulting in an incidence density of 0.0279 person-years. Yin deficiency was associated with all-cause mortality (HR, 95% CI: 1.39, 1.02-1.90). This study indicates that individuals diagnosed with Yin deficiency in TCM, characterized by symptoms such as thirst, reduced urine volume, hard stool, and hot flushes, had a 39% higher risk of all-cause mortality.

Discussion

The findings may provide information for TCM practitioners on tailoring treatment plans for persons with type 2 diabetes. No conclusive statements can be made on the basis of the preliminary data presented here. Controlled prospective studies are warranted.

Decision Tree-Based Body Constitution Diagnosis System for Traditional Chinese Medicine

This study aimed to establish a method for fast and accurate determination of body constitution types from the body constitution questionnaire (BCQ) by employing a decision tree model. The model was trained for 4 classes, namely, Yin-Xu, Yang-Xu, Phlegm and Blood Stasis, and Normal, and it achieved 67% accuracy for the testing dataset. The model also reduced the required number of BCQ questions from 44 to 3–6, depending on the responses. Lastly, we developed the Traditional Chinese Medicine (TCM) body constitution online diagnosis system using our model to collect data digitally and use it more practically and efficiently. This system can assist doctors to improve the diagnosis and treatment in TCM practice.

The Relationship between the Second-Generation Antipsychotics Efficacy and the Traditional Chinese Medicine Body Constitutions in Patients with Schizophrenia

Background: Schizophrenia requires lifelong treatment; Second-generation Antipsychotics (SGAs) have become the most prescribed medication for schizophrenia patients. The efficacy of various SGAs treatment may differ in schizophrenia patients with various traditional Chinese medicine (TCM) body constitution (BC) types. Method: This study applied a longitudinal quantitative research design, where a total of 66 participants were recruited. The Positive and Negative Symptom Scale (PANSS) and the Clinical Global Impression (CGI) score were used to evaluate patients’ psychopathology status in hospitalization, and body constitution questionnaires were conducted by face-to-face interviews in the 1st, 3rd, and 6th week of hospitalization. Results: More than 60% of schizophrenia patients who were treated with SGAs were classified to have unbalanced BC types including Yin-Xu, Yang-Xu and Stasis. Generalized estimating equation analysis revealed significant time effects in CGI and PANSS score improvements in both unbalanced and gentleness (balance) BC types, but no significant changes in the group and group-time interaction in the CGI and PANSS scores in different BC type groups. Conclusions: Schizophrenia patients under SGAs treatment had a higher proportion of unbalanced BC types which may lead to poorer physical or mental statuses, such as overweight problems. Health care providers could apply interventions according to patients’ BC types for disease prevention.

Efficacy and Safety of TangWang Prescription for Type 2 Non-Proliferative Diabetic Retinopathy: A Study Protocol for a Randomized Controlled Trial

Background: Diabetic retinopathy (DR) is one of the most common and severe microvascular complications of diabetes mellitus (DM), which results in blindness among adults worldwide. Presently, the efficacy of drug treatments for diabetic retinopathy (DR) is not satisfactory, thus urgently necessitating effective drug treatment measures. TangWang prescription (TWP) has been found to have retinal protection effects in previous clinical and basic research. However, there is a lack of rigorous, randomized, and controlled studies. This study aims to evaluate the efficacy and safety of TWP in delaying the development of DR.

Methods: This study is a randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial, consisting of 384 participants to be randomized in a 1:1 ratio in the treatment and control groups. Furthermore, the treatment and control groups will be administered the TangWang prescription and the placebo, respectively, each at a dose of one bag twice a day. The study period will last for 48 weeks. The primary outcome measure will be the changes in the degree of retinal microvascular lesions before and after treatment. The secondary outcome will be changes in the degree of hemangioma, microvascular bleeding, microvascular leakage, macular edema, and vision. All statistical tests will be two-sided, and a p < 0.05 will be considered statistically significant.

Discussion: We hypothesize that the patients with DR will benefit from TangWang prescription, and in addition to the central random system and platform of dynamic information collection, the patients’ conditions will be monitored, and the data collected for analysis. If successful, this study will provide evidence that the TWP formulation delays in the progression of DR.

Trial registration: The design of this trial has been registered with the ClinicalTrials.gov (NCT03025399).

Constitutions of Deficiency and Stasis of Traditional Chinese Medicine and Related Factors among Middle-Aged Women in Taiwan

Background

Traditional Chinese medicine (TCM) appears to be the common therapy in middle-aged women. The constitution serves as a guide for TCM treatment. However, little is known about the constitution and related factors in middle-aged women. The objectives of this study were to describe the yang-deficiency, yin-deficiency, and stasis constitutions in middle-aged women. Demographic and health factors related to yang deficiency, yin deficiency, and stasis were also examined.

Methods

A total of 1,000 women aged 40–65 years were selected from 2009 through 2018 using random sampling from the Taiwan Biobank Research Database in Taiwan. Yang-deficiency, yin-deficiency, and stasis were assessed using the body constitution questionnaire. Multiple logistic regression analysis was used to identify factors associated with constitution in deficiency or stasis.

Results

The proportions of middle-aged women who had the constitution in yang-deficiency, yin-deficiency, and stasis were 29.7%, 21.7%, and 17.7%, respectively. The result of binary logistic regression showed that current menstruation, abnormal spirometry, and education level were predictive factors of yang deficiency. Women with younger age, abnormal spirometry, or a vegetarian diet had a significantly associated yin deficiency. Younger age, abnormal spirometry, and coffee habit were predictors of stasis.

Conclusions

Middle-aged women in Taiwan with abnormal spirometry had a higher risk for deficiency or stasis constitutions, especially for those younger than 56 years. Healthcare providers should learn patients' constitutions and provide appropriate advice, referring them to safe providers of their desired method.

Using Chinese Body Constitution Concepts and Measurable Variables for Assessing Risk of Coronary Artery Disease

Background

Identifying patients with high risk of coronary artery disease (CAD) is often difficult in outpatient clinic settings. This study aimed to explore if the measurement of body constitution can be adopted to predict the risk of CAD diagnosis. The objective of this study is to conduct a prospective observational study and a case-control study to answer the research question.

Study Design

Part 1 (prospective observational study): a total of 143 patients with chest pain and admitted to receive cardiac catheterization were enrolled, and 108 of them were diagnosed with CAD. Part 2 (case-control study): the above 108 CAD patients and 476 healthy controls matched by age and gender from the participants of Taiwan Biobank were adopted for comparison.

Main Outcome Measures

The body constitution of both patients and healthy controls were measured by the Body Constitution Questionnaire (BCQ). Each one received scores of Yang-Xu (Yang-deficiency), Yin-Xu (Yin-deficiency), and Stasis. These 3 scores together with demographic characteristics and CAD risk factors were used in the logistic multiple regression model to predict the risk of CAD.

Results

(Part 1) No difference was found between the scores of Yang-Xu, Yin-Xu, and Stasis between the patients with and without CAD. (Part 2) The scores of Yang-Xu, Yin-Xu, and Stasis of the CAD patients were significant higher those of the healthy controls. Yang-Xu and Stasis scores were obtained with age, BMI, and hypertension in the model with prediction rate 89.0%. The area under receiver operating characteristic curve of this model was 0.896.

Conclusions

This study is the first to apply Chinese body constitution concepts and measurable variables to assess the risk of having CAD of the patients with chest pain prior to receiving cardiac catheterization. The higher scores of Yang-Xu and Stasis were found to be risk factors. Our results revealed that BCQ has the potential to be a first-line diagnostic tool for patients with chest pain to facilitate early recognition and diagnosis of CAD.

Cohort profile: the Lanxi Cohort study on obesity and obesity-related non-communicable diseases in China

PURPOSE

The Lanxi Cohort was established to systematically investigate the aetiology and interplay of body fat distribution and multiple factors with obesity and obesity-related non-communicable diseases in China.

PARTICIPANTS

The baseline investigation of the Lanxi Cohort study took place between June 2015 and August 2017 in Lanxi, Zhejiang Province, China. Permanent residents from one urban community and four rural villages were involved in this study. The baseline investigation included questionnaire survey, physical examination, dual-energy X-ray absorptiometry (DXA) scan, blood samples collection and traditional Chinese medicine (TCM) inquiry.

FINDINGS TO DATA

A total of 5132 participants, aged 18 to 80 years, were recruited at baseline; among them, 38.7% were men and 64.8% were from the urban area. The mean age was 53.04±12.77 years. The completion rates of physical examination, DXA scan, blood collection and TCM inquiry were 99.9%, 98.5%, 99.9% and 96.5%, respectively. The mean body mass index (BMI) was 23.42±3.20 kg/m² with 8.1% of the study population being obese (BMI ≥28 kg/m²). The crude prevalence of hypertension, diabetes and metabolic syndrome were 34.9%, 10.0% and 30.4%, respectively.

FUTURE PLANS

All participants will be monitored annually for cause-specific mortality and morbidity and hospital admission and will be followed up by in-person survey every 4 years. The baseline population is considered to expand in the future depending on the availability of funding support.

ETHICS APPROVAL

This study was approved by the Ethical Committee of the School of Public Health, Zhejiang University.

Identification of Traditional Chinese Medicine Constitutions and Physiological Indexes Risk Factors in Metabolic Syndrome: A Data Mining Approach

Objective

In order to find the predictive indexes for metabolic syndrome (MS), a data mining method was used to identify significant physiological indexes and traditional Chinese medicine (TCM) constitutions.

Methods

The annual health check-up data including physical examination data; biochemical tests and Constitution in Chinese Medicine Questionnaire (CCMQ) measurement data from 2014 to 2016 were screened according to the inclusion and exclusion criteria. A predictive matrix was established by the longitudinal data of three consecutive years. TreeNet machine learning algorithm was applied to build prediction model to uncover the dependence relationship between physiological indexes, TCM constitutions, and MS.

Results

By model testing, the overall accuracy rate for prediction model by TreeNet was 73.23%. Top 12.31% individuals in test group (n=325) that have higher probability of having MS covered 23.68% MS patients, showing 0.92 times more risk of having MS than the general population. Importance of ranked top 15 was listed in descending order . The top 5 variables of great importance in MS prediction were TBIL difference between 2014 and 2015 (D_TBIL), TBIL in 2014 (TBIL 2014), LDL-C difference between 2014 and 2015 (D_LDL-C), CCMQ scores for balanced constitution in 2015 (balanced constitution 2015), and TCH in 2015 (TCH 2015). When D_TBIL was between 0 and 2, TBIL 2014 was between 10 and 15, D_LDL-C was above 19, balanced constitution 2015 was below 60, or TCH 2015 was above 5.7, the incidence of MS was higher. Furthermore, there were interactions between balanced constitution 2015 score and TBIL 2014 or D_LDL-C in MS prediction.

Conclusion

Balanced constitution, TBIL, LDL-C, and TCH level can act as predictors for MS. The combination of TCM constitution and physiological indexes can give early warning to MS.

Association of TCM body constitution with insulin resistance and risk of diabetes in impaired glucose regulation patients

Background

Impaired glucose regulation (IGR) patients have increased risk of type 2 diabetes mellitus (T2DM). Identifying relevant risk factors in IGR subjects could facilitate early detection and prevention of IGR progression to diabetes. This study investigated the association between Traditional Chinese Medicine (TCM) body constitution and serum cytokines, and whether body constitution could independently predict diabetes in IGR subjects.

Method

Patients with IGR (n = 306) received a blood test and their body constitution type was assessed using a body constitution questionnaire (BCQ). Serum levels of cytokines were measured by ELISA. Patients were followed up for at least three years, and their status of diabetes were recorded. Multivariate logistic regression was used to estimate odds ratios (ORs) of diabetes for body constitution.

Results

Phlegm-damp, Damp-heat and Qi-deficiency were three most common unbanlenced constitutions among IGR subjects. Phlegm-damp and Damp-heat constitution subjects showed higher serum levels of interleukin 6 (IL-6), tumour necrosis factor-α (TNF-α), leptin and lower serum levels of adiponectin (P<0.05). Qi-deficiency constitution subjects showed higher serum levels of leptin and lower serum levels of adiponectin, glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) (P<0.05). Subjects with Phlegm-damp or Damp-heat constitution demonstrated a significantly higher risk of diabetes (P<0.05).

Conclusion

Phlegm-damp and Damp-heat TCM body constitution are strongly associated with abnormal serum cytokines, and could potentially serve as a predictor of diabetes in IGR subjects. Body constitution can help to identify IGR subjects who are at a high risk of progression to diabetes.

Administration of Traditional Chinese Blood Circulation Activating Drugs for Microvascular Complications in Patients with Type 2 Diabetes Mellitus

Traditional Chinese medicine (TCM) is an important complementary strategy for treating diabetes mellitus (DM) in China. Traditional Chinese blood circulation activating drugs are intended to guide an overall approach to the prevention and treatment of microvascular complications of DM. The core mechanism is related to the protection of the vascular endothelium and the basement membrane. Here, we reviewed the scientific evidence underpinning the use of blood circulation activating drugs to prevent and treat DM-induced microvascular complications, including diabetic nephropathy (DN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (DR). Furthermore, we summarized the effects and mechanism of TCM on improving blood rheology, inhibiting aggregation of platelet, forming advanced glycation end products (AGEs), regulating oxidative stress, reducing blood fat, and improving lipid metabolism. The paper provides a new theoretical basis for the clinical practice of TCM in the prevention and treatment of DM and its microvascular complications.