Abstract
BackgroundAcupuncture is widely used to treat diabetic patients with dyspeptic symptoms suggestive of gastroparesis in China. We conducted this systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of acupuncture for diabetic gastroparesis (DGP).MethodsWe searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and four Chinese databases including China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database (CBM) and WanFang Data up to January 2013 without language restriction. Eligible RCTs were designed to examine the efficacy of acupuncture in improving dyspeptic symptoms and gastric emptying in DGP. Risk of bias, study design and outcomes were extracted from trials. Relative risk (RR) was calculated for dichotomous data. Mean difference (MD) and standardized mean difference (SMD) were selected for continuous data to pool the overall effect.ResultsWe searched 744 studies, among which 14 RCTs were considered eligible. Overall, acupuncture treatment had a higher response rate than controls (RR, 1.20 [95% confidence interval (CI), 1.12 to 1.29], P < 0.00001), and significantly improved dyspeptic symptoms compared with the control group. There was no difference in solid gastric emptying between acupuncture and control. Acupuncture improved single dyspeptic symptom such as nausea and vomiting, loss of appetite and stomach fullness. However, most studies were in unclear and high risk of bias and with small sample size (median = 62). The majority of the RCTs reported positive effect of acupuncture in improving dyspeptic symptoms.ConclusionsThe results suggested that acupuncture might be effective to improve dyspeptic symptoms in DGP, while a definite conclusion about whether acupuncture was effective for DGP could not be drawn due to the low quality of trials and possibility of publication bias. Further large-scale, high-quality randomized clinical trials are needed to validate this claim and translate this result to clinical practice.
Highlights
Acupuncture is widely used to treat diabetic patients with dyspeptic symptoms suggestive of gastroparesis in China
In which the main intervention was moxibustion or acupuncture combined with Chinese materia medica, were excluded because the reported effects in these studies did not arise from needle-penetrating acupuncture or the effects were confounded by Chinese materia medica, while trials in which the main intervention was acupuncture combined with acupuncture-related assistant techniques were included because the effect of these studies was from stimulation of acupoints by acupuncture or its assistant techniques
Of 14 trials, six studies used acupuncture [20,22,25,26,28,29], five studies used EA [19,21,24,31,32], one study used warm acupuncture [30], one trial used acupuncture combined with acupoint application [23] and another study used acupuncture combined with chiropractic [27]
Summary
Acupuncture is widely used to treat diabetic patients with dyspeptic symptoms suggestive of gastroparesis in China. Diabetic gastroparesis (DGP) is a common autonomic neuropathy which affects more than 5% diabetic patients [1,2] It affects nutritional state and adversely impacts on glycemic control and quality of life in diabetes. With the accumulating evidence of acupuncture for gastrointestinal tract and definite diagnosis of diabetic gastroparesis, some acupuncturists in China have realized that acupuncture might have potential effects in treating diabetic gastroparesis. During the last 20 years, Chinese acupuncturists performed many clinical studies to evaluate the effectiveness of acupuncture for diabetic gastroparesis. Most of these studies had a small sample sizes, a conclusion of pooled effect about acupuncture on DGP remained to draw. The present study was conducted to assess the quality of trials and the effect of acupuncture on treating diabetic gastroparesis
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