Study on the Prognosis Effect of Traditional Chinese Medicine Treatment in Patients with Diabetic Neuropathy – A Nationwide, Population-based Study in Taiwan

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Abstract
Background: Diabetic neuropathy (DN) is one of the common chronic complications, leading to limb disability and increased risks of hospitalization and mortality. Traditional Chinese medicine (TCM) has been commonly applied in Taiwan as an adjunctive treatment to ameliorate diabetes-associated chronic complications, including neuropathy. Aim: We aimed to investigate whether the clinical treatment of DN combined with TCM can reduce the associated hospitalization and mortality using the National Health Insurance Research Database (NHIRD) of Taiwan. Methods: We selected 1,152 patients with DN who received TCM treatment as the study cohort group, and 4,940 patients with DN who did not receive TCM treatment from Taiwan NHIRD were further matched 1:1 for sex, age, and index year as the comparison cohort group. Cox proportional hazards analysis was performed to compare hospitalization and mortality during a mean follow-up period of 15 years. Results: A total of 687/225 enrolled patients (29.82%/9.77%) had hospitalization/mortality, including 298/97 in the TCM group (25.87%/8.42%) and 389/128 in the comparison group (33.77%/11.11%). Cox proportional hazard regression analysis showed a lower rate of hospitalization and mortality for patients in the TCM group (adjusted hazard ratio [HR] of 0.434, 95 confidence interval [CI] =0.172–0.798, P < 0.001; adjusted HR of 0.689, 95 CI = 0.372–0.981, P = 0.039). The Kaplan–Meier analysis showed that the cumulative risk of hospitalization and mortality in the study and comparison cohort groups was significantly different (log-rank P < 0.001 and P = 0.007, respectively). Conclusion: Our results suggest that the application of TCM might be beneficial for patients with DN to lower the risks of hospitalization and mortality; however, further prospective cohort studies are still required to confirm our observations.

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