Metabolic Dysfunction-Associated Fatty Liver in type 2 diabetes mellitus patient: Can a systematic review of and Meta-Analysis of commonly used TCM-preparation shed light on their efficacy?

Jingsi Cao¹Tingting Bao²Jingxian Cao³Xuechun Fan¹Yanyan Wang⁴Jing Yu⁴Ying Wang¹Ruixue Deng¹Jingjing Shi²Changlong Shen⁵Qingwei Li^2*Jia Mi^4*

• ¹College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
• ²Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
• ³College of Traditional Chinese Medicine, Ningxia Medical University, Yinchuan, Ningxia Hui Region, China
• ⁴Department of Endocrinology, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
• ⁵Gastroenterology department , Yanji/Yanbian Traditional Chinese Medicine Hospital, Yanji, China

Background：Type 2 diabetes mellitus (T2DM) and Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) are mutually causal, which can jointly promote the development of the disease. As an important means to evaluate the steatosis of MAFLD, Controlled Attenuation Parameter (CAP) can also evaluate the metabolism related fat parameters. Whether Traditional Chinese Medicine preparation (TCM-preparation) can improve CAP has not been reported yet, so the purpose of this meta-analysis is to evaluate the effect of TCM-preparation on CAP in T2DM patients with MAFLD.Methods: In this meta-analysis, eight databases were searched from the establishment of the database to April 23, 2025, to obtain clinical randomized controlled trials (RCTs) of TCM-preparation or TCM-preparation combined with Standard Biomedical Treatment (SBT) in the treatment of T2DM complicated with MAFLD. After screening the literature and extracting the data, Meta-analysis was conducted using RevMan5.4 software, with results presented in the form of a forest plot. This study was registered with PROSPERO (CRD42024569613).Results：A total of 599 papers were retrieved, and the papers were screened according to the nadir and ranking criteria, and finally 8 trials (648 participants) were included in this study. Meta-analysis showed that TCM-preparation significantly reduced CAP values in patients with T2DM combined with MAFLD compared with TCM-preparation (MD = -10.26, CI [-15.33, -5.18], P < 0.00001).Conclusion: TCM-preparation can reduce the CAP value of T2DM combined with MAFLD and can have a good therapeutic effect on glucose-lipid metabolism level and liver function, indicating that TCM-preparation can reduce the deposition of hepatic fat, restore the function of hepatocytes, and have a positive effect on T2DM combined with MAFLD; however, due to the heterogeneity of the included literature, it needs to be further validation by high-quality trials.