Effectiveness and Safety of Astragalus-containing Chinese Medicine Combined with Western Medicine for Diabetes: A Systematic Review and Meta-Analysis

Abstract

Introduction: This study aims to comprehensively summarize the clinical evidence comparing the effectiveness and safety of integrating astragalus-containing Chinese medicines with western medicines for T2DM. Methods: Six databases were searched for eligible studies from inception to June 2023. The aggregated outcomes were expressed as odds ratio (OR) or standardized mean difference (SMD). Random effect model was used for statistical analyses. The risk of bias for included studies was assessed with the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed with the Grades of Recommendations Assessment, Development and Evaluation approach. Results: The results showed a significant improvement in the FPG (SMD -0.98; 95%CI -1.23, -0.72), 2hPG (SMD -0.94; 95%CI -1.13, -0.76), HbA1c (SMD -0.97; 95%CI -1.18, -0.75), HOMA-IR (SMD -1.07; 95%CI -1.47, -0.66), HOMA-β (SMD 0.84; 95%CI 0.38, 1.31), HDL (SMD 0.41; 95%CI 0.17, 0.66), LDL (SMD -1.17; 95%CI -1.62, -0.72), TC (SMD -0.83; 95%CI -1.06, -0.59) and TG (SMD -0.93, 95%CI -1.20, -0.65) with astragalus-containing TCMs plus conventional therapy comparing to conventional therapy alone. The incidence of hypoglycemia and gastrointestinal tract adverse events was significantly reduced in the combination group. Subgroup analyses based on the type of western medicines, type of traditional Chinese medicines, baseline glucose level, follow-up duration and disease subtypes, all indicated the similar results regarding the superior effectiveness in the combination group. Discussion: The meta-analyses suggested the astragalus-containing TCMs plus WMs surpassed WMs monotherapy in terms of decreasing the FPG, 2hPG and HbA1c level. Our results were limited by the quality of trials included in the meta-analyses. Conclusion: Add-on therapy of astragalus-containing TCMs was generally more effective in ameliorating the glycolipid metabolism and improving insulin resistance. The clinical benefits of integrative therapies remained in different subgroup patients. © 2026 The Author(s). Published by Bentham Science Publishers, 2026. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.