Lack of Evidence on Tai Chi-Related Effects in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

Abstract

Aims:

Whether Tai Chi (TC) benefits patients with type 2 diabetes mellitus (T2DM) remains controversial. Thus, we performed a meta-analysis to assess the efficacy of TC in T2DM patients.

Methods:

A computerised search through PubMed and Embase was performed to identify relevant studies. The primary outcomes were fasting blood glucose (FBG), haemoglobin A1c (HbA1c) and insulin resistance (HOMA). Secondary outcomes included total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglyceride. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated.

Results:

4 randomised controlled trials (RCTs) and 5 non-randomised controlled trials (NRCTs) met the inclusion criteria. The pooled WMDs from RCTs were −14.82 mg/dL (95% CI: −49.17 to 19.53; P=0.40) for FBG, −0.19% (95% CI: −0.41 to 0.03; P=0.09) for HbA1c and −0.34 units (95% CI: −3.02 to 2.34; P=0.80) for HOMA. The WMDs from NRCTs were −11.22 mg/dL (95% CI: −18.58 to −3.86; P=0.003) for FBG, −0.41% (95% CI: −0.53 to −0.29; P<0.00001) for HbA1c and −0.60 units (95% CI: −1.46 to 0.25; P=0.16) for HOMA. Furthermore, the pooled results of serum lipids suggest that TC significantly reduced triglyceride (P=0.006) instead of total cholesterol (P=0.77), and failed to improve HDL-C (P=0.12).

Conclusions:

Sufficient evidence to support the benefits of TC to T2DM patients is lacking. Further large-scale studies are needed to investigate the long-term efficacy of TC.

Key words

diabetes mellitus - Tai Chi - meta-analysis

*

^* The first 2 authors contributed equally to this work.

• References

• 1 Colberg SR, Sigal RJ, Fernhall B et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33: e147-e167
• 2 Bloomgarden ZT. Inflammation, atherosclerosis, and aspects of insulin action. Diabetes Care 2005; 28: 2312-2319
• 3 Benfield T, Jensen JS, Nordestgaard BG. Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome. Diabetologia 2007; 50: 549-554
• 4 Tian T, Zhang LQ, Ma XH et al. Diabetes mellitus and incidence and mortality of gastric cancer: a meta-analysis. Exp Clin Endocrinol Diabetes 2012; 120: 217-223
• 5 Morrato EH, Hill JO, Wyatt HR et al. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care 2007; 30: 203-209
• 6 Ostergard T, Jessen N, Schmitz O et al. The effect of exercise, training, and inactivity on insulin sensitivity in diabetics and their relatives: what is new? Appl Physiol Nutr Metab 2007; 32: 541-548
• 7 Temelkova-Kurktschiev T, Stefanov T. Lifestyle and genetics in obesity and type 2 diabetes. Exp Clin Endocrinol Diabetes 2012; 120: 1-6
• 8 Yeh SH, Chuang H, Lin LW et al. Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease of cytotoxic T-cell population in type 2 diabetic patients. Diabetes Care 2007; 30: 716-718
• 9 Wang JH. Effects of Tai Chi exercise on patients with type 2 diabetes. Med Sport Sci 2008; 52: 230-238
• 10 Hung JW, Liou CW, Wang PW et al. Effect of 12-week tai chi chuan exercise on peripheral nerve modulation in patients with type 2 diabetes mellitus. J Rehabil Med 2009; 41: 924-929
• 11 Yeh SH, Chuang H, Lin LW et al. Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase in T-bet transcription factor and IL-12 production. Br J Sports Med 2009; 43: 845-850
• 12 Liu X, Miller YD, Burton NW et al. A preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome, glycaemic control, health-related quality of life, and psychological health in adults with elevated blood glucose. Br J Sports Med 2010; 44: 704-709
• 13 Song R, Ahn S, Roberts BL et al. Adhering to a t’ai chi program to improve glucose control and quality of life for individuals with type 2 diabetes. J Altern Complement Med 2009; 15: 627-632
• 14 Chen SC, Ueng KC, Lee SH et al. Effect of t’ai chi exercise on biochemical profiles and oxidative stress indicators in obese patients with type 2 diabetes. J Altern Complement Med 2010; 16: 1153-1159
• 15 Lam P, Dennis SM, Diamond TH et al. Improving glycaemic and BP control in type 2 diabetes. The effectiveness of tai chi. Aust Fam Physician 2008; 37: 884-887
• 16 Tsang T, Orr R, Lam P et al. Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes: a randomised double-blind sham-exercise-controlled trial. Age Ageing 2008; 37: 64-671
• 17 Zhang Y, Fu FH. Effects of 14-week Tai Ji Quan exercise on metabolic control in women with type 2 diabetes. Am J Chin Med 2008; 36: 647-654
• 18 Thomas GN, Hong AW, Tomlinson B et al. Effects of Tai Chi and resistance training on cardiovascular risk factors in elderly Chinese subjects: a 12-month longitudinal, randomized, controlled intervention study. Clin Endocrinol (Oxf) 2005; 63: 663-669
• 19 Xin L, Miller YD, Brown WJ. A qualitative review of the role of qigong in the management of diabetes. J Altern Complement Med 2007; 13: 427-433
• 20 Maher CG, Sherrington C, Herbert RD et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003; 83: 713-721
• 21 Liberati A, Altman DG, Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
• 22 Higgins JP, Thompson SG, Deeks JJ et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
• 23 Schulz KF, Grimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet 2002; 359: 614-618