基于临床实践指南选择糖尿病中医研究问题

Selecting future research questions for diabetes in Chinese medicine based on clinical practice guidelines

目的系统分析目前中医临床实践指南中糖尿病研究证据分布情况。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、WanFang Data、VIP、CBM数据库及相关指南网站,搜集2023年12月之前发布的中医、中西医结合有关糖尿病的指南。对纳入指南的证据分布信息进行系统梳理。结果27部糖尿病相关中医指南的内容主要涵盖了辨证论治、专病专药、饮食、外治法、传统功法等方面。纳入的指南涉及三种证据分级标准,其总体证据级别主要集中于中、低水平(67.3%),其中糖尿病骨质疏松症、糖尿病心肌病、糖尿病前期、糖尿病周围神经病变相关指南中高等级证据占比较低,分别仅有7.2%、7.6%、13.2%和13.3%。仅糖尿病肾病指南有关于中药毒性的证据信息,其他指南均未涉及。针刺、太极拳、八段锦等特色疗法在不同类型并发症中的证据级别存在较大差异。低级别证据主要集中于糖尿病及相关并发症的辨证论治、辨症治疗、辨体征治疗、辨指标治疗、中成药、专病专方等方面。结论目前,指南中低/无证据支持的意见、新增主题、指南间不一致内容、交叉靶点的证据源、经典名方、中药毒性、中医特色疗法等可以为今后糖尿病中医研究提供选题方向,倡议针对性解决糖尿病相关重要问题,从而提高研究价值,减少不必要、重复研究和资源浪费,推进中医糖尿病研究领域的良性发展。

Objective To systematically analyze the distribution of research evidence on diabetes in current clinical practice guidelines of Chinese medicine(CM).Methods The PubMed,Embase,Cochrane Library,CBM,WanFang Data,CNKI,VIP databases and related guideline websites were electronically searched to collect clinical practice guidelines for CM in diabetes published before December 2023.We systematically reviewed the distribution of evidence in these guidelines.Results The 27 CM guidelines on diabetes mainly covered syndrome differentiation and treatment,specific disease-specific drugs,diet,external therapies,and traditional exercises.The included guidelines used three different levels of evidence grading,with most of the evidence falling into the low-to-moderate level(67.3%).However,guidelines on diabetes-related osteoporosis,diabetic cardiomyopathy,prediabetes,and diabetic peripheral neuropathy had a relatively low proportion of high-level evidence,accounting for only 7.2%,7.6%,13.2%,and 13.3%respectively.Only guidelines on diabetic nephropathy provided evidence on the toxicity of Chinese herbal medicine,while other guidelines did not cover this aspect.Acupuncture,Tai Chi,Baduanjin,and other characteristics therapies had varying levels of evidence for different types of complications.Low-level evidence mainly focused on syndrome differentiation and treatment,symptom-based treatment,sign-based treatment,indicator-based treatment,Chinese patent medicine,specific disease-specific formulas,etc.,for diabetes and related complications.Conclusion Currently,topics supported by low/no evidence,new themes,inconsistent content between guidelines,evidence sources for overlapping targets,classical formulas,toxicity of Chinese herbal medicine,and characteristic CM therapies can provide directions for future research on CM in diabetes.We advocate addressing important issues related to diabetes specifically,to improve research value,eliminate unnecessary duplication of studies and resource waste,and promote the healthy development of CM research in the field of diabetes.