Abstract
ObjectiveManual acupuncture has commonly been used in China, either alone or in combination with conventional medicine, to treat diabetic peripheral neuropathy (DPN). The objective of this study was to perform a systematic review to evaluate the potential benefits and harms of manual acupuncture for DPN to justify its clinical use.MethodsWe searched for published and unpublished randomized controlled trials of manual acupuncture for DPN till 31 March 2013. Revman 5.2 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).ResultsA total of 25 trials involving 1649 participants were included. The methodological quality of included trials was generally poor. Meta-analysis showed that manual acupuncture had better effect on global symptom improvement compared with mecobalamin (RR 1.31, 95%CI 1.21 to 1.42), vitamin B1 and B12 (RR 1.55, 95%CI 1.33 to 1.80), and no treatment (RR 1.56, 95%CI 1.31 to 1.85), and that the combination of manual acupuncture and mecobalamin had better effect compared with mecobalamin alone on global symptom improvement (RR 1.56, 95%CI 1.28 to 1.90). Adverse events were not reported in any trials. The asymmetric funnel plot suggested publication bias.ConclusionsDespite the number of trials of manual acupuncture for DPN and their uniformly positive results, no clinically relevant conclusions can be drawn from this review due to the trials’ high risks of bias and the possibility of publication bias. Clearly defined and internationally acknowledged outcome measures are required for future study. There remains an urgent need for training Chinese researchers in conducting unbiased trials as well as prospectively registering all initiated Chinese trials to avoid publication bias.
Highlights
World Health Organization (WHO) data suggest that there will be 353 million people with diabetes mellitus by 2030 [1]
Acupuncture is an alternative medicine therapy originating in ancient China, and it has been used since ancient times to treat symptoms of diabetic neuropathy
For the diagnostic criteria of diabetes, 18 trials used the WHO diagnostic criteria [11,12,13,14,15,16,18,19,20,22,24,25,26,27,29,30,31,33], six trials used the diagnostic criteria of the American Diabetes Association (ADA) [17,23,28,32,34,35], and one trial used the criteria of the China Guideline for Diabetes Prevention and Treatment [21]
Summary
World Health Organization (WHO) data suggest that there will be 353 million people with diabetes mellitus by 2030 [1]. Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. Acupuncture is an alternative medicine therapy originating in ancient China, and it has been used since ancient times to treat symptoms of diabetic neuropathy. There are different types of acupuncture in China, including manual body acupuncture, scalp acupuncture, auricular acupuncture, electroacupuncture, acupoint injection, moxibustion (an external method of preventing and treating diseases by ignition of moxa to stimulate the acupuncture points), and so on. Many Traditional Chinese Medicine (TCM) practitioners consider this practice is closer to TCM theory because it allows individualized treatment for different syndrome of TCM diagnosis, and is recommended for the treatment of DPN [3]. Manual acupuncture refers to treating patients by inserting thin, solid needles into acupuncture points (acupoint) on the skin. The needles are often manipulated by the practitioner, with the intention of eliciting the
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