The Comparison between Chinese Traditional medicine and Low Carbohydrate Diet on the treatment of Type 2 diabetes, a randomized Controlled Trail

. Diabetes is a crucial problem that the world is facing, especially type 2 diabetes because of the large number of patients and the death brought by it. This paper compares specifically two treatments of type 2 diabetes – low carbohydrate diet (LCD) and Chinese traditional medicine (CTM), through an RCT. Participants are randomly assigned to three groups – low carbohydrate diet group, Chinese traditional medicine group and the control group. The conclusion got from the comparisons between the data of three groups shows that both LCD and CTM are effective in treating type 2 diabetes since they show statistically significant decreases in blood glucose levels, A1c levels, and waist circumferences, and there is no statistically significant difference between their effectiveness. This work proves the validity of the two treatments and provides the foundation for further research on the treatments of both type 1 and 2 diabetes.


Introduction
Diabetes is always a huge problem worldwide. It does not only kill 1.5 million people directly, 48% of them are younger than 70 years old, but also causes 46000 kidney diseases death cases [1]. Specifically, type 2 diabetes patients occupy more than 95% of the total diabetes patient [2]. This type of diabetes is caused by genes, resulting in insulin resistance in the body, which means body cells do not respond to insulin, and thus cannot get glucose from the blood, blood glucose level will rise with the time [3,4]. Early study has shown low carbohydrate diets can lead to diabetes remission without side effects. In the total 23 trials, including 1357 participants, suggest that LCDs did a better job than the control diets on diabetes remission (defined as HbA1c < 6.5%), at six months. At 12 months, data on remission is not significant. Other clinical improvements, weight loss, triglycerides, and insulin sensitivity, were shown at 6 months. Besides, at both 6 and 12 months, no important clinical indications: adverse events, or blood lipids, between groups were seen [5]. On the other hand, traditional Chinese medicines like Huanglian Decoction (HLD) are potential treatments for type 2 diabetes. In a period of 4 weeks of treatment with HLD on rats, biochemical indicators like fasting blood glucose and insulin sensitivity index were greatly improved. Additionally, metabolomics results show that biomarkers like cytosine, glucose, and betaine were regulated. The reason behind * Corresponding author email: daniel.tan.lihe@gmail.com this is that HLD can improve the performance of gene and protein expression levels [6]. Although much research has been put forward studying the treatments for type 2 diabetes, no study has been put forward to the comparison between low-carbohydrate diets and Chinese traditional medicines in the aspect of treating type 2 diabetes. This paper aims to compare LCD and CTM in the treatment of type 2 diabetes, and in the treatment of 3 months, LCD may show a significant decrease in blood glucose level, A1c level, and body weight, hence having a better effect on treating type 2 diabetes patients.

Methodology
This experiment includes three groups, a participant ratio of 1:1:1, carried out in Wuxi, China. Volunteers are being called after informing them of the detailed experiment, they need to be Chinese males, documented type 2 diabetes (defined as A1c up to 7%), be aged between 18-60, and be over-weighted (defined as BMI between 25.9 to 29.9). Exclusion criteria are surgeries in the past 6 months, alcohol, and other genetic diseases & endocrine diseases. 30 participants are selected and divided into three groups randomly -Low carbohydrate diet (LCD) group, Chinese traditional medicine (CTM) group, and the control group. In addition, all participants were asked to sign the "Consent form" before the protocol started.
Note: this research was approved by the Ethics committee in Victoria, Canada Fig. 1. Study flow diagram [7].
Before starting the protocol, all candidates need to complete a 10-15-day washout period as shown in Figure  1. Their diet will be the same, food will be provided. In the LCD group, 10 participants are included. Each of them will receive the same diet containing 54.7±0.05 grams of carbohydrates every day. A sample menu is listed below [8].
Breakfast: Breakfast bowl with 2 eggs, 1 tomato, and 1 cup of cubed avocado.
Dinner: 85 g grilled chicken with 78 g roasted Brussels sprouts and 93 g cooked quinoa.
In the CTM group, these 10 people would receive a typical Chinese traditional medicine called Huanglian Doctrine. They will eat them three times a day after each meal, and 3 pills each time. In the control group, the diet is the same as the CTM group, otherwise remain their normal lifestyle. Noted that in all three groups, the amount of other major nutrients: protein, lipids, vitamins, and minerals need to be as same as possible between the 3 groups. Biomarkers were measured before and monthly during the interventions. Anthropometric measurements: height, weight, and BMI are measured. Fasting blood samples are taken at the same time to measure the blood glucose level and A1c.

Result
After doing the interventions, the hypothesis was rejected, the low-carbohydrate diet did not show a better result in treating type 2 diabetes from the perspective of blood glucose level. Instead, both LCD and CTM groups show a decrease in blood glucose levels without significant difference, in other words, they are both effective in treating type 2 diabetes. Table 1 contains the anthropometric measure throughout the study. Table 2 has the laboratory results.

Discussion
According to the results, both groups show they can effectively lower the blood glucose level & A1c level in a period of treatment for 3 months. According to Figure 2, there is no significant change in all candidates' height, As shown in Figure 3 and Figure 4, there is no significant change in weight and BMI for the candidates in the CTM group and Control group either. However, due to the lower intake of carbohydrates, which is the main source of energy, candidates in the LCD group present decreases in their weights and BMIs. The vital biomarkers that need to pay much attention to are waist circumference, blood glucose level, and A1c level. Figure 5, Figure 6, and Figure 7 clearly indicate the decreasing trend of LCD's and CTM's candidates' waist circumference, blood glucose level, and A1c level, as the candidates' three biomarkers remain the same in the control group. Based on the table and graph shown, there is no significant difference between the effectiveness of LCD and CTM, hence it contradicts my hypothesis stating that LCD is a better treatment than CTM for lowering the blood glucose level and A1c level. It fits the previous study mentioned in the introduction. LCDs are proven to be effective in type 2 diabetes. CTM is only effective on rats as stated in the previous study, now it is proven that CTM is also practical in treating type 2 diabetes in humans. However, limitations are also present in the experiment. Age is restricted. All candidates are adults, no evidence shows the impact on children and elders. Also, the race is restricted. Candidates are all Chinese, and the effects of both treatments on non-Chinese are still unclear. And not enough evidence has shown CTM has the same effect on non-Chinese people as Chinese people. Lastly, the experiment period may not be enough. 3 months is considered short-term, and the result may vary over a longer period. Further study can be conducted for a longer period since the effect for a longer period is still unclear. Additionally, research on the treatment of type 1 diabetes using LCD or CTM is also worth conducting.

Conclusion
According to the experiment, both low carbohydrate diet and Chinese traditional medicine are effective in treating type 2 diabetes, as they show statistically significant decreases in blood glucose levels, A1c levels, and waist circumferences. Especially noted that there is no significant difference between the effectiveness of the two treatments. Nevertheless, the result of the experiment should only be considered within its limitations. The effectiveness of other lifestyle-based treatments for Type 2 diabetes is still unclear due to insufficient studies [9].