Abstract
BackgroundDiabetic peripheral neuropathy (DPN) is very common in people with diabetes. Chinese herbal medicine (CHM) therapy has been developed for DPN empirically over the years. The aim of this systematic review and meta-analysis was to assess the efficacy and safety of CHMs for patients suffering from DPN.MethodsWe performed a meta-analysis of randomized-controlled clinical trials (RCTs) evaluating the efficacy and safety of CHM on DPN. Six databases were searched up to November 2012. The primary outcome measures were the absolute values or changing of motor or sensory nerve conduction velocity (NCV), and the secondary outcome measurements were clinical symptoms improvements and adverse events. The methodological quality was assessed by Jadad scale and the twelve criteria recommended by the Cochrane Back Review Group.ResultsOne hundred and sixty-three studies claimed RCTs. Ten studies with 653 individuals were further identified based on the Jadad score ≥3. These 10 studies were all of high methodological quality with a low risk of bias. Meta-analysis showed the effects of NCV favoring CHMs when compared with western conventional medicines (WCM) (P<0.05 or P<0.01). There is a significant difference in the total efficacy rate between the two groups (P<0.001). Adverse effects were reported in all of the ten included studies, and well tolerated in all patients with DPN.ConclusionDespite of the apparently positive findings and low risk of bias, it is premature to conclude the efficacy of CHMs for the treatment of DPN because of the high clinical heterogeneity and small sample sizes of the included studies. However, CHM therapy was safe for DPN. Further standardized preparation, large sample-size and rigorously designed RCTs are required.
Highlights
Diabetic peripheral neuropathy (DPN) is one of the most common comorbidities of diabetes
The definition of diabetic neuropathy used in the studies had to accord with the following diagnostic criteria: (1) diabetes mellitus was diagnosed according to the internationally recognized criteria, such as the World Health Organization criteria [31] or the American diabetes association criteria [32]; (2) the patient had a predominantly distal symmetrical sensorimotor polyneuropathy of the limbs, including subjective complaints of pain, tingling, numbness, weakness, and reduced functioning of the peripheral nerves demonstrated by a nerve conduction test; (3) other causes of sensorimotor polyneuropathy were excluded
A total of 653 participants of Chinese ethnicity were included in the 10 studies, of whom 316 were male and 302 were female ranging from 25 to 71 years old
Summary
Diabetic peripheral neuropathy (DPN) is one of the most common comorbidities of diabetes. DPN is a complex and progressive disorder, characterized by symmetrical distal degeneration of peripheral nerves, leading to symptoms of pain and sensory loss. Annalisa [2] reported that 14.1% of people with diabetes had DPN in UK and 23.1% in Italy respectively. In the US, approximately one-third of people with diabetes aged 40 or older were diagnosed as DPN [3]. A recent study reported that 11% were diagnosed with DPN in young children, with short diabetes duration, and good diabetes control [4]. Diabetic peripheral neuropathy (DPN) is very common in people with diabetes.
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