title: Integrative traditional Chinese medicine therapy reduces the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus.
abstract: BACKGROUND
  Life-long insulin is the standard treatment for type 1 diabetes mellitus (T1DM). The role of traditional Chinese medicine (TCM) in T1DM is still not clear. The aim of this study is to explore the prescription pattern of TCM and its impact on the risk of diabetic ketoacidosis (DKA) in patients with T1DM.
  
  
  METHODS
  We retrieved samples from the registry for catastrophic illness patients from the National Health Insurance Research Database (NHIRD). Based on a frequency (1:4) matched case-control design, patients with T1DM in 2000-2011 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with T1DM was analyzed. The incidence of DKA and the annual costs of emergency visits and hospitalizations were evaluated for all causes.
  
  
  RESULTS
  Overall, 416 subjects were TCM users, whereas a total of 1608 matched subjects were classified as non-TCM users. The most common Chinese herbal formula and single herb is Liu-wei-di-huang-wan (Six-ingredient pill of Rehmannia) and Huang-qi (Radix Astragali; Astragalus membranaceus (Fisch.) Bunge, Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao), respectively. Compared with non-TCM users, we found a 33% reduction in DKA incidence for all TCM users (aHR 0.67, 95% CI 0.56-0.81, p <0.000) and a 40% reduction for users receiving TCM treatment for more than 180 days (aHR 0.58, 95% CI 0.41-0.82, p <0.01). There were no significant differences between TCM users and non-users in the frequency and medical costs of emergency visits and hospitalizations.
  
  
  CONCLUSIONS
  Integrative TCM use may reduce the risk of DKA in patients with T1DM. Our results suggest that TCM may have a substantial positive impact on the management of TIDM.
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University, Taipei 100, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
authors.forename: Angela Shin-Yu
authors.initials: AS
authors.lastname: Lien
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
authors.forename: Yi-Der
authors.initials: YD
authors.lastname: Jiang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Mou
authors.affiliation: Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan.
authors.forename: Mao-Feng
authors.initials: MF
authors.lastname: Sun
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University, Taipei 100, Taiwan. Electronic address: bsgau@ntu.edu.tw.
authors.forename: Bih-Shya
authors.initials: BS
authors.lastname: Gau
authors.affiliation: Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan. Electronic address: hungrongyen@gmail.com.
authors.forename: Hung-Rong
authors.initials: HR
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016022:Case-Control Studies; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000639:trends*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D016527:Drug Costs; D011307:Drug Prescriptions; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008516:Medicine, Chinese Traditional / Q000191:economics / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D012042:Registries; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D004365:Drugs, Chinese Herbal; D007004:Hypoglycemic Agents
keywords: Astragalus membranaceus (Fisch.) Bunge; Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao: diabetic ketoacidosis; National Health Insurance Research Database; Traditional Chinese medicine; Type 1 diabetes mellitus