Acupuncture for the Management of Chronic Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of Randomized Trials

Introduction/Aim: Peripheral neuropathy is a common cause of chronic pain among patients with diabetes, and acupuncture has been suggested as a therapeutic option. To determine the effectiveness of acupuncture for chronic diabetic peripheral neuropathy (DPN). Methods: We searched MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, PsychINFO, trial registries, and reference lists of relevant articles up to February 2017. Pairs of reviewers, independently and in duplicate, screened articles for inclusion, assessed risk of bias and extracted data. We conducted meta-analyses when possible and used the GRADE approach to assess the quality of evidence. Results: Among 4443 potentially eligible studies 4 with 244 patients proved eligible to be included for review.1 Overall all four studies were at high risk of bias. Compared to sham acupuncture, we found very low quality evidence that acupuncture reduces pain (weighted mean difference [WMD] −1.95cm on a 10cm visual analogue scale, 95% CI −3.27 to −0.64; minimally important difference [MID] 1cm; risk difference (RD) for achieving the MID 52%; 95% CI 19% to 63%) and improves physical functioning (WMD 3.68 points on the short form-36 [SF-36] physical component summary score; 95% CI 1.66 to 5.70; MID is 5-points; RD for achieving the MID 8%, 95% CI 3% to 18%), but does not affect emotional functioning (WMD 1.26 points on the SF-36 mental component summary score, 95% CI: −1.13 to 3.66). Conclusions: Very low-quality evidence suggests that acupuncture reduces pain and improves physical functioning in patients with chronic DPN but does not affect emotional functioning.