Mulberry Twig Alkaloids for Type 2 Diabetes Mellitus: A System Review and Meta-analysis

Yibin Feng ^1* Guoming Chen ¹ Ruifeng Yang ² Xiaoya Yang ³ Jiazhen Jiang ³ Yudan Guo ³ Mengshan Xu ³ Yi Chen ³ Yining Hou ³ Cheng Zhang ¹ Ning Wang ¹

• ¹ The University of Hong Kong, Pokfulam, Hong Kong, SAR China
• ² Beijing University of Chinese Medicine, Beijing, Beijing Municipality, China
• ³ Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China

Background: Diabetes has emerged as a significant global health concern, with over 95% of the cases being categorized as Type 2 Diabetes Mellitus (T2DM). The disease not only imparts detrimental effects on individual health but also exerts a substantial burden on societal economics and healthcare systems. Notably, there is a paucity of meta-analysis on the efficacy of Mulberry Twig Alkaloids (MTA) for treating T2DM. Methods: The Systematic review registration number is CRD42024523218. Retrieving Cochrane Library, Clinicaltrials.gov, Embase, PubMed, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), Scopus, Chongqing VIP, CINAHL, SinoMed, ChiCTR, and WanFang Data from the establishment to February 1, 2024 for herbal products related randomized controlled trials (RCT). The risk of bias assessment and meta-analysis were operated by Review Manager 5.4 and Stata 15.0. TSA software 0.9.5.10 version was used to estimate whether the results achieved the amount of required information size (RIS). The GRADE profiler 3.6 software was used to estimate the quality of evidence for the outcomes. Results: Nine studies were included, containing a total of ten trials with 1178 patients. The results indicated that MTA was more effective than placebo in reducing HbAlc (glycated hemoglobin), and MTA combined with hypoglycemic drugs was better than hypoglycemic drugs alone in HbAlc, FBG (fasting blood glucose), and 2hPG (2-hour postprandial glucose). In terms of lipid control, MTA combined with hypoglycemic drugs owned better control of TG (triglycerides) and LDL (low-density lipoprotein) efficacy compared to hypoglycemic drugs alone. After MTA treatment, there was no damage to liver function compared to placebo. The safety of MTA alone or in combination with hypoglycemic drugs was comparable to that of hypoglycemic drugs alone. Conclusion: For T2DM patients, MTA was more effective than placebo. MTA combined with hypoglycemic drugs were better than hypoglycemic drugs alone. The safety of MTA was equivalent to that of hypoglycemic drugs. However, due to the heterogeneity and possible bias, the results still need to be prudently treated.