title: Integrating traditional Chinese medicine healthcare into diabetes care by reducing the risk of developing kidney failure among type 2 diabetic patients: a population-based case control study.
abstract: BACKGROUND
  Our previous study indicated that the traditional Chinese medicine (TCM) formula Liu-Wei-Di-Huang-Wan, which consists of six type of herbs, namely Rehmannia glutinosa (Gaertn.) DC., root, dried; Cornus officinalis Siebold & Zucc., fructus, dried; Dioscorea oppositifolia L., root, dried; Alisma plantago-aquatica subsp. orientale (Sam.) Sam., tuber, dried; Paeonia × suffruticosa Andrews, bark, dried; Poria cocos (Fr.) Wolf., sclerotium, dried, is the most frequently prescribed herbal formula used to treat type 2 diabetes patients. The aim of the study was to evaluate the integration of TCM into diabetes care in terms of how it reduces the risk of developing kidney failure.
  
  
  METHODS
  The Taiwan׳s National Health Insurance Research Database (NHIRD) provided detailed information of health care services for each patient and covers 98% of all Taiwan residents as of 2007. Case and control subjects were selected from the NHIRD. Two multivariable logistic regression models were constructed in order to explore two types of exposure assessments including prescription of TCMs (model 1) and prescription of different estimated dosages of Liu-Wei-Di-Huang-Wan (model 2).
  
  
  RESULTS
  Using logistic regression model 1, having used TCMs was independently associated with a decreased risk of kidney failure by multivariable analysis (OR=0.69, 95% CI: 0.61-0.77). Using logistic regression model 2, there was no difference between non-Liu-Wei-Di-Huang-Wan TCM users and Liu-Wei-Di-Huang-Wan TCM users in terms of the risk of developing kidney failure. Furthermore, there was also no linear dose-response trend when we used exposure to prescribed Liu-Wei-Di-Huang-Wan as a continuous variable (for non-Liu-Wei-Di-Huang-Wan TCM users, OR=0.68, 95% CI: 0.60-0.77; for TCM users consuming 1-30 g of Liu-Wei-Di-Huang-Wan, OR=0.69, 95% CI: 0.54-0.87; for >30 g of Liu-Wei-Di-Huang-Wan, OR=0.84, 95% CI: 0.49-1.44).
  
  
  CONCLUSIONS
  Integrating TCM healthcare into diabetes care was found to be associated with a decreased risk of developing kidney failure. Having recognized the use of TCM, exploring any potential interactions and adverse effects, and integrating both technologies into a holistic treatment system may be beneficial to the relief of diabetic nephropathy on patients with type 2 diabetes.
authors.affiliation: Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Road, Taipei 11221, Taiwan; Department of Chinese Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Hsu
authors.affiliation: Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Road, Taipei 11221, Taiwan.
authors.forename: Yueh-Ting
authors.initials: YT
authors.lastname: Tsai
authors.affiliation: Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Road, Taipei 11221, Taiwan; Department of Chinese Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan. Electronic address: kareny@ms10.hinet.net.
authors.forename: Jung-Nien
authors.initials: JN
authors.lastname: Lai
authors.affiliation: Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Road, Taipei 11221, Taiwan.
authors.forename: Chien-Tung
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, No.155, Sec. 2, Li-Nong Road, Taipei 11221, Taiwan; Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
authors.forename: Shun-Ku
authors.initials: SK
authors.lastname: Lin
authors.affiliation: Department of Traditional Medicine, Wan Fang Hospital, Taipei Medical University, Taipei , Taiwan.
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced*; D012306:Risk; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; C476907:liu-wei-di-huang wan
keywords: Chinese herbal product; Diabetes; Kidney failure; Liu-Wei-Di-Huang-Wan; National Health Insurance Research Database; Traditional Chinese medicine