Safety and effectiveness of Traditional Chinese Medicinal herbs for diabetic foot: a systematic review and Meta-analysis

Objective

To evaluate the safety and effectiveness of traditional Chinese medicinal herbs (TCMHs) as an adjunctive treatment for diabetic foot (DF).

Methods

The sources used were PubMed (1966 to August 2015), the Cochrane Library (1988 to August 2015), the Excerpta Medica Database (1974 to August 2015), Wiley (1807 to August 2015), Ovid (1988 to August 2015), ClinicalTrials.gov (1993 to August 2015), the Cochrane Central Register of Controlled Trials (1966 to August 2015), China Science and Technology Journal Database (1994 to August 2015), ChiCTR (2007 to August 2015), SinoMed (1978 to August 2015), the China National Knowledge Infrastructure (1984 to August 2015), Wanfang Data Knowledge Service Platform (1998 to August 2015), and the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) (1984 to August 2015). Studies were identified and selected, and the data were extracted by two independent reviewers. The Cochrane Risk of Bias tool was used to assess the quality of studies. Revman 5.2 software was used for data synthesis and analysis.

Results

Sixteen studies were included based on the selection criteria. Of these, seven studies had low bias risk and one had high bias risk. In the overall analysis, TCMHs resulted in a significantly higher total effective rate (OR 5.08; 95% CI 3.50 to 7.36; P < 0.000 01), cure rate (OR 2.12; 95% CI 1.63 to 2.77; P < 0.000 01), and shorter time to ulcer healing (SMD ?0.64; 95% CI ?0.89 to ?0.40; P < 0.000 01) when compared with non-TCMHs treated DF. The analysis also revealed that significantly fewer amputations occurred in TCMHs patients (OR 0.36; 95% CI 0.20 to 0.65; P = 0.0007). Sensitivity analysis indicated that the findings of the Meta-analysis were robust to study quality, and the funnel plot of the Egger test showed no publication bias.

Conclusion

TCMHs intervention appears to be more effective for DF, with a similar safety profile, when compared with non-TCMHs treatments, although this result requires further verification with more well-designed studies.