Effect of Tai Chi on Quality of Life, Body Mass Index, and Waist-Hip Ratio in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

The health-related quality of life of patients with type 1 and type 2 diabetes mellitus: a meta-analysis

PURPOSE

We need to know about the health-related quality of life (HRQoL) of patients with diabetes mellitus (DM) to assess their health outcomes. Quantitative studies have discussed whether patients with Type 1 DM (T1DM) have better HRQoL than those with Type 2 DM (T2DM) or vice versa. However, no meta-analyses have addressed the HRQoL of patients with T1DM and T2DM together. Therefore, the primary objective of this meta-analysis was to investigate the HRQoL of patients with T1DM and T2DM. The secondary objective of this meta-analysis was to use various scales to assess the HRQoL of patients with T1DM and T2DM.

METHODS

The inclusion criteria were (1) study participants were diagnosed with T1DM and T2DM and were aged 18 years or older, (2) outcome measure was HRQoL as assessed by appropriate instruments, (3) study written in the English language, (4) research articles using quantitative research methods, (5) study with full-text access, and (6) study reporting the necessary statistics to calculate the effect size. Cohen's d was used to calculate effect sizes, while the random effect model was used to calculate the joint effect size.

RESULTS

The sample consisted of seven articles, which recruited a total of 4.896 patients with DM. Patients with T1DM and T2DM had similar HRQoL. According to the EQ-5D-5L, patients with T1DM had a higher HRQoL than those with T2DM. According to the EQ-5D-VAS and SF-36, patients with T1DM and T2DM had similar HRQoL. The Egger's regression analysis indicated no publication bias.

CONCLUSION

Our results are sample-specific and cannot be generalized to all patients with DM. Therefore, more research is warranted on this topic.

Metabolic impairments associated with type 2 diabetes mellitus and the potential effects of exercise therapy: An exploratory randomized trial based on untargeted metabolomics

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a common condition that is characterized by metabolic impairments. Exercise therapy has proven effective in improving the physiological and psychological states of patients with T2DM; however, the influence of different exercise modalities on metabolic profiles is not fully understood. This study first aimed to investigate the metabolic changes associated with T2DM among patients and then to evaluate the potential physiological effects of different exercise modalities (Tai Chi and brisk walking) on their metabolic profiles.

METHODS

This study included 20 T2DM patients and 11 healthy subjects. Patients were randomly allocated to either the Tai Chi or walking group to perform Dijia simplified 24-form Tai Chi or brisk walking (80-100 m/min), with 90 minutes each time, three times per week for 12 weeks, for a total of 36 sessions. The healthy group maintained daily living habits without intervention. Glycemic tests were conducted at the baseline and after 12 weeks. Serum and urine samples were collected for untargeted metabolomic analyses at baseline and 12 weeks to examine the differential metabolic profiles between T2DM and healthy subjects, and the metabolic alterations of T2DM patients before and after exercise therapy.

RESULTS

Compared to the healthy group, T2DM patients exhibited metabolic disturbances in carbohydrates (fructose, mannose, galactose, glycolysis/gluconeogenesis), lipids (inositol phosphate), and amino acids (arginine, proline, cysteine, methionine, valine, leucine, and isoleucine) metabolism, including 20 differential metabolites in the serum and six in the urine. After exercise, the glycemic results showed insignificant changes. However, patients who practiced Tai Chi showed significant improvements in their post-treatment metabolic profiles compared to baseline, with nine serum and six urine metabolites, including branch-chained amino acids (BCAAs); while those in the walking group had significantly altered nine serum and four urine metabolites concerning steroid hormone biosynthesis and arachidonic acid metabolism compared to baseline.

CONCLUSION

T2DM patients displayed impaired carbohydrate, lipid, and amino acid metabolism, and exercise therapy improved their metabolic health. Different modalities may act through different pathways. Tai Chi may improve disrupted BCAAs metabolism, whereas brisk walking mainly regulates steroid hormone biosynthesis and arachidonic acid metabolism.

The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis

Background

Limited research directly compares the clinical effects of different types of mind-body exercises on anxiety and depression in older adults. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that meet the inclusion criteria to explore the intervention effects of five different types of mind-body exercises in improving anxiety and depression in older adults.

Methods

We followed the PRISMA-NMA guidelines and conducted searches in the Web of Science, PubMed, the Cochrane Library, and Embase databases up to July 28, 2023. The language was limited to English. Two independent reviewers conducted literature screening and data extraction. Review Manager 5.4 was used to perform Pairwise meta-analysis and risk assessment, while STATA version 15 software was used for network meta-analysis.

Result

A total of 42 studies, involving 2974 participants, were included. The results of the traditional meta-analysis showed that mind-body exercises were superior to the control group in alleviating anxiety (SMD: -0.87, 95% CI: -1.43, -0.31, p<0.05, I2 = 95%) and depressive (SMD: -0.52, 95% CI: -0.71, -0.34, p<0.05, I2 = 80%). In the network meta-analysis, the ranking of treatment effects for anxiety showed that Tai Chi > Qigong > Yoga > Dance > control group, while for depression, the ranking showed Tai Chi > Pilates > Yoga > Qigong > Dance > control group.

Conclusion

This study found that mind-body exercises have positive effects on improving anxiety and depression in older adults. Among the five different types of mind-body exercise interventions, Tai Chi was considered an effective approach for improving anxiety and depression. However, we encourage older adults to choose exercise modalities that suit their interests to enhance adherence.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023464296.

Lifestyle intervention Tai Chi for adult patients with type 2 diabetes mellitus: a PRIO-harms based overview of 17 systematic reviews

Objective

To systematically summarize current evidence and determine the clinical effectiveness and safety of Tai Chi for type 2 diabetes mellitus (T2DM) in adults by conducting an overview of systematic reviews (SRs).

Methods

A systematic search encompassing five electronic databases was conducted until July 30, 2023, to identify relevant systematic reviews (SRs) based on randomized controlled trials (RCTs) concerning Tai Chi for T2DM. The methodological quality of the included SRs was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Risk of Bias in Systematic Reviews (ROBIS) tool. The Preferred Reporting Items for Overview of Systematic Review (PRIO-harms) checklist was used to promote a more balanced reporting of benefits and harms in this overview. Corrected covered area (CCA) was used to calculate the degree of overlapping primary studies. Primary outcome measures were glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), while secondary outcomes encompassed health-related quality measures. The GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) framework was utilized to assess the quality of evidence for the outcome measures.

Results

A total of 17 eligible SRs were included in this overview. One SR reported negative conclusions, while the remaining 16 reported positive ones on different outcomes. A total of 4 SRs reported adverse events, either absent or minor. Most of the SRs exhibited critically low quality (15/17) and a high risk of bias (14/17), as indicated by AMSTAR2 and ROBIS, respectively. The CCA was 12.14%, indicating a high degree of primary study overlapping. Evidence from 135 results for 24 outcomes concerning Tai Chi for T2DM was evaluated using the GRADE approach, most of which were rated very low.

Conclusion

Tai Chi shows promise as a potentially effective and safe lifestyle intervention for adults with T2DM, particularly in improving HbA1c, FBG, BMI, and overall quality of life (QoL). However, these results should be cautiously interpreted due to methodological flaws observed in the current SRs and the low quality of the SRs based on GRADE. Furthermore, there is a compelling need for additional well-designed, high-quality RCTs and SRs to establish robust and conclusive evidence regarding the efficacy of Tai Chi for managing T2DM in the future.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42019140988.

Effects of Tai Chi in diabetes patients: Insights from recent research

Tai Chi, a practice that combines elements of both exercise and mindfulness, offers a wide range of health benefits. The body of evidence concerning the impact of Tai Chi on diabetes has recently been growing. This editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes (T2D). The review includes 3 randomized controlled trials (RCTs) and 5 systematic reviews and meta-analyses, all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with T2D. Tai Chi demonstrates a significant effect to enhance glycemic control, lower blood pressure, improve serum lipid profiles, reduce insulin resistance, positively influence obesity-related indices, and improve overall quality of life in individuals with T2D. However, it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin resistance. The author also delves into potential mechanisms by which Tai Chi may exert its influence on the human body. Finally, the editorial highlights the critical issues that warrant further exploration in the future.

Types of Nursing Intervention on Improving Quality of Life among Patients with Diabetes Mellitus: A Systematic Review

BACKGROUND

Long-term treatment of patients with diabetes mellitus (DM) is considered a major factor causing disease complications. DM complications mostly impact the patient's quality of life (QoL). Only a few studies have been conducted summarizing the types of nursing interventions for improving the QoL of DM patients.

OBJECTIVE

The objective of this study is to explore the types of nursing interventions that can improve the QoL of DM patients.

METHODS

The online databases, including ScienceDirect, Medline, Google Search, and Pro-Quest, were used to search for the relevant articles. Articles that met the inclusion criteria were analyzed, and their level of evidence was determined and synthesized.

RESULTS

A total of 30 articles defining the types of nursing intervention on improving the QoL of DM patients were discovered, comprising the five types of nursing interventions, such as health education (15 articles), exercise (8 articles), WhatsApp/short message service (WA/SMS) gateway (3 articles), blood glucose control (3 articles), and black garlic herbal therapy (1 article).

CONCLUSION

Sequentially, the most common types of nursing interventions to improve the QoL of DM patients was health education, followed by exercise, WA/SMS gateway, and glucose control. A personal approach to health education is a significant point in improving the QoL of DM patients in the future. The findings of this study might not be strongly generalized, so further randomized controlled trial (RCT) studies with larger samples are needed.

Human metabolism and body composition: prospects for novel studies

CONTEXT

Most articles on gut microbiota argue the importance of body composition assessment in patients; however, body composition assessments are fragile (ie, with methodological limitations) in the most recent studies.

OBJECTIVE

To present two suggestions for further research using the human body composition assessment.

METHODS

The methods used in this study are based on a Pinto et al article published in Nutrition Reviews.

DATA EXTRACTION

On the basis of data.

obtained from the PubMed, SCOPUS, LILACS, and Web of Science databases, Pinto et al provided a current survey of intermittent fasting protocols and an understanding of the outcomes to date in terms of the profile of the intestinal microbiota in obese organisms.

DATA ANALYSIS

Of the 82 original articles identified from the databases, 35 were eliminated because of duplication and 32 were excluded for not meeting the inclusion criteria. Two additional articles found in a new search were added, yielding a total of 17 studies to be included in this review. Among the protocols, alternate-day fasting and time-restricted feeding were the most common, and they were shown to have different mechanisms of metabolic signaling. Time-restricted feeding influences body mass control and biochemical parameters by regulating the circadian system and improving satiety control systems by acting on leptin secretion. In contrast, alternate-day fasting leads to a reduction of ±75% of all energy consumption regardless of dietary composition, in addition to promoting hormonal adjustments that promote body mass control. Furthermore, both protocols could remodel the intestinal microbiota by changing the Firmicutes to Bacteroidetes ratio and increasing the abundance of strains such as Lactobacillus spp. and Akkermansia that have a protective effect on metabolism against the effects of body mass gain.

CONCLUSION

Changes in adipose tissue (eg, body mass loss, control, gain) should be interpreted via the sum of skinfolds in absolute values, waist perimeter, and patients' body proportionality, because fat is just a fraction of the adipocyte (lipid).

Exploring the efficacy of traditional Chinese medicine exercise in alleviating anxiety and depression in older adults: a comprehensive study with randomized controlled trial and network meta-analysis

Background

Anxiety and depression pose a significant global health challenge for elderly individuals. Research has demonstrated the potential of traditional Chinese medicine (TCM) exercise therapies in alleviating these conditions. However, ongoing debate and uncertainty persist regarding the optimal therapy and its impact on anxiety and depression. This study aims to evaluate and prioritize TCM exercise therapies for anxiety and depression in older adults, to identify the most effective intervention, and to provide a basis for informed decision-making in clinical practice.

Methods

We conducted a comprehensive search of electronic databases including The Web of Science, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wang Fang, and Wei Pu database up to July 2022. Two researchers independently reviewed all included studies and extracted relevant data. Traditional meta-analysis was performed using Review Manager version 5.4, while network meta-analysis was conducted using STATA software version 15.1 to generate network evidence plots and funnel plots.

Result

A total of 30 trials, involving 2,806 participants, met the eligibility criteria. The traditional meta-analysis revealed that TCM exercise significantly improved anxiety (SMD = -0.82, 95% CI = -1.39, -0.26, p = 0.004) and depression (SMD = -0.63, 95% CI = -0.85, -0.41, p < 0.01) compared to the control group. In the network meta-analysis, Tai Chi exercise was ranked as the most effective intervention for anxiety (68.3%), followed by Yi Jin Jing (63.6%). For depression, the Tai Chi exercise was ranked as the most effective (87.8%), followed by the Ba Duan Jin exercise (74.1%).

Conclusion

TCE exercise can improve anxiety and depression in older adults, Among the four TCE exercise therapies included, Tai Chi exercise showed better efficacy than other types of treatment. Nevertheless, further research is required to validate the effectiveness of this exercise therapy through larger and more rigorous clinical trials.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023438697.

Comparing the Effects of Bafa Wubu Tai Chi and Traditional He-Style Tai Chi Exercises on Physical Health Risk Factors in Overweight Male College Students: A Randomized Controlled Trial

The aim of this study was to evaluate the effects of Bafa Wubu Tai Chi (BW-TC) and traditional He-style Tai Chi (TH-TC) exercises on physical health risk factors in overweight male college students and to compare the effectiveness of the two Tai Chi exercise forms in improving these risk factors.

METHODS

Eighty-one overweight male university students between the ages of 18 and 23 were randomly assigned in a 1:1:1 ratio to the BW-TC group, TH-TC group, and control group (CG). The Tai Chi exercise training consisted of 12 weeks, three times a week, for 60 min per session. The CG attended three health lectures and maintained their normal study routine. The outcomes were body composition and blood lipids. Data were collected at baseline and post-intervention and analyzed using one-way ANOVA and mixed-design ANOVA.

RESULTS

At baseline, there were no significant differences in demographic characteristics and assessed parameters (p > 0.05) among the groups. The BW TC and TH TC groups both significantly decreased their body weight (2.69 kg, 2.04 kg, respectively), body mass index (0.90 kg/m², 0.67 kg/m², respectively), body fat percentage (1.46%, 1.10%, respectively), low-density lipoprotein cholesterol (8.82 mg/dL, 9.27 mg/dL, respectively), total cholesterol (8.57 mg/dL, 9.34 mg/dL, respectively) and triglycerides (10.14 mg/dL, 10.63 mg/dL, respectively); and increased their muscle mass (-0.56 kg, -1.13 kg, respectively) and high-density lipoprotein cholesterol (-5.77 mg/dL, -6.37 mg/dL, respectively). Multiple comparisons showed that both Tai Chi groups were significantly better than the CG in improving the evaluated parameters.

CONCLUSIONS

Two types of Tai Chi interventions were effective in improving body composition and blood lipids in overweight university students, without significant differences between the two.

The effectiveness of lifestyle interventions for diabetes remission on patients with type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Conventional wisdom affirmed that diabetes was irreversible, but current research shows that lifestyle interventions may achieve diabetes remission among patients with type 2 diabetes mellitus. Recently, many original studies have examined the effectiveness of lifestyle interventions. However, great heterogeneity in intervention approaches resulted in inconsistent intervention effects.

AIMS

The aim of this study was to determine the effectiveness of lifestyle interventions for diabetes remission among patients with type 2 diabetes mellitus.

METHODS

PubMed, CINAHL, Embase, Web of Science Core Collection, and Cochrane Library were searched for relevant articles from their inceptions to March 26, 2021. Reference lists and a relevant journal were searched manually as well. Both randomized controlled trials and quasi-experimental studies were included. The quantitative data extracted from the selected studies included diabetes remission rate, weight, and quality of life score. The risk of bias was assessed by the Cochrane and Joanna Briggs Institute's tool. RevMan version 5.3. was used to carry out the meta-analysis.

RESULTS

This systematic review included 12 studies involving 3997 patients with type 2 diabetes mellitus. Lifestyle interventions included in the studies were mainly divided into diet-only interventions and diet combined with physical activity interventions. Among them, there were three types of diet: (1) low-energy diet, (2) low carbohydrate diet, and (3) Mediterranean diet. Moderate-intensity aerobic and resistance physical activity, walking, and maintaining habitual physical activity were the three types of physical activity interventions employed in the included studies. The results indicated that lifestyle interventions were effective for achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus.

LINKING EVIDENCE TO ACTION

Lifestyle interventions were associated with significant effects on diabetes remission, reducing weight, and improving quality of life. As an important part of lifestyle interventions, diet and physical activity have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus. It is therefore suggested that the contents of lifestyle interventions should focus on diet and physical activity.

The effects of Tai Chi on glucose and lipid metabolism in patients with diabetes mellitus: A meta-analysis

OBJECTIVE

The research aims to evaluate effects of the Tai Chi exercise therapy on glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM).

DESIGN

Systematic review and meta-analysis of existing literature were undertaken.

METHODS

Seven electronic resource databases were scanned to collect eligible studies. Two reviewers selected studies, the meta-analysis was performed with RevMan 5.3 after quality evaluation.

RESULTS

Nineteen RCT trails involved in 18 reports were included in the meta-analysis, involving 1220 research objects. The results show that the Tai Chi exercise group is better than the control group in decreasing fasting blood glucose (FBG) (MD = - 0.79, 95 %CI (- 1.73, - 0.68), p < 0.0001), glycated hemoglobin (HbA1c) (MD = - 1.10, 95 % CI (- 1.78, - 0.43), p = 0.001), triglyceride (TG) (MD = - 0.23, 95 % CI (- 0.32, - 0.15), p < 0.0001) and in increasing the concentration of high-density lipoprotein cholesterol (HDL-C) (MD = 0.15, 95 % CI (0.11, 0.20), p < 0.0001) of T2DM patients.

CONCLUSIONS

Tai Chi exercise therapy shows significant superiority in improving the FBG, HbA1c, TG, and HDL-C in T2DM patients. It can be used as one of the exercise prescriptions for prevention and treatment of T2DM patients.

The Comparative Effectiveness of Traditional Chinese Medicine Exercise Therapies in Elderly People With Mild Cognitive Impairment: A Systematic Review and Network Meta-Analysis

Background

Mild cognitive impairment (MCI) in the elderly is a health problem worldwide. Studies have confirmed that traditional Chinese medicine (TCM) exercise therapies can improve MCI. However, which therapy is the best and their impacts on brain function remain controversial and uncertain. This study aims to compare and rank TCM exercise therapies for MCI in the elderly, and analyze their effects on brain function, in order to find an optimal intervention and provide a basis for clinical treatments decision-making.

Methods

The Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials, China National Knowledge Infrastructure (CNKI), Wangfang database, China Science and Technology Journal Database, and Chinese Biomedical Medicine (CBM) were searched through October 28, 2021. Two researchers reviewed all the studies and extracted the data. The ADDIS software version 1.16.8 and the Bayesian hierarchical model were used for pair-wise meta-analysis and network meta-analysis, and the STATA software version 14.0 was used to draw the network evidence plots and funnel plots.

Results

A total of 23 studies on 2282 participants were included in this study. In the pair-wise meta-analysis, TCM exercise therapies (Baduanjin exercise, Tai Chi, Liuzijue exercise and finger exercise) were superior to non-TCM exercise therapies (stretching and toning exercise, usual care, health education and routine daily activities) in terms of MMSE, MoCA and ADL outcomes. In the network meta-analysis, the MMSE outcome ranked Baduanjin exercise (78%) as the best intervention and Tai Chi (36%) as the second. The MoCA outcome ranked Baduanjin exercise (62%) as the best intervention. For the ADL outcome, Baduanjin exercise (60%) ranked the best, and followed by finger exercise (43%).

Conclusion

TCM exercise therapies may improve the cognitive function in elderly patients with MCI. Among the four therapies included, the Baduanjin exercise may be the preferred therapy for MCI in the elderly, and its mechanism may be related to the regulation of cognitive-related brain function and structure.

Systematic Review Registration

https://inplasy.com, identifier: INPLASY202070006.

Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine

ABSTRACT

This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance.

The Effect of Physical Activity on Body Constitution and Psychological Health in Older Adults: Evidence From an Analysis of a Biobank Research Database

This study aims to describe the relationship between physical activity, suboptimal health status based on traditional Chinese medicine, and psychological health in older people in Taiwan. A total of 4,497 older individuals were selected from the Taiwan Biobank Research Database. Suboptimal health status was assessed using a body constitution questionnaire to measure yang deficiency, yin deficiency, and stasis. The results showed that older adults involved in physical activity had a lower likelihood of yang/yin deficiency and stasis constitutions than physically inactive people. Participants with yang deficiency or stasis constitutions had a higher likelihood of poor psychological health, whereas those with yin deficiency had a greater likelihood of depression. People involved in physical activity had a lower likelihood of depression than physically inactive people. Compared with male older adults, females had a lower percentage of physical activity habits, poorer body constitutions, and poorer psychological health.

The Effects of Tai Chi Exercise for Patients with Type 2 Diabetes Mellitus: An Overview of Systematic Reviews and Meta-Analyses

OBJECTIVES

Tai chi (TC) is a potential complementary treatment for type 2 diabetes mellitus (T2DM). This overview systematically summarizes and evaluates the existing evidence of TC in the treatment of T2DM.

METHODS

Systematic reviews (SRs)/meta-analyses (MAs) on TC interventions for T2DM were comprehensively searched in seven databases. Methodological quality, risk of bias, reporting quality, and quality of evidence were assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

Eight published SRs/MAs were included in our study. Based on the methodology and quality of evidence assessment, all SRs/MAs are considered to be of very low quality, and only 1 SR/MA has been assessed as low risk of bias, and none of the SR/MA has been fully reported on the checklist. A total of 65 outcome indicators extracted from the included SRs/MAs were evaluated, and only 1 item was assessed as high quality.

CONCLUSIONS

TC may be an effective and safe complementary treatment for T2DM. However, this conclusion must be treated with caution because the quality of the evidence provided by the included SRs/MAs is generally low.