The acupuncture role in treatment of diabetic peripheral neuropathy

Abstract

Back ground: Diabetes mellitus is a global epidemic and in Malta, about 13.9% of the adult population is affected .The diabetic peripheral sensorimotor polyneuropathy is the most common Diabetic complication with the estimated prevalence in the range of 6.95%-9.73% in the Maltese population where the pharmaceutical therapy has very limited effect with high potential of side effects. Objectives: To assess the clinical effectiveness and safety of acupuncture treatment for the management of diabetic peripheral neuropathy (DPN) as an add on complimentary treatment Methodology: A total of about thirteen databases were systemically researched the period of the last 11 years (2006-2017). Total population of 1070 was included. The new modified quality assessment tool STRICTA Plus Score Scale (SPSS) was used in this study to assess the quality of methodology design and reporting of the included RCTs. RCTs with score of >9 and active control treatments such as sham acupuncture or medical therapy were included. Out of a total of 63 potentially relevant articles which were retrieved in this literature review study, eventually, sixteen studies met the inclusion criteria and included in the actual assessment and the final analysis. Research language was limited to English; however reviews in Chinese were included and translated. Results: The total efficacy rates in acupuncture treatment groups ranged from 83.33% to 95%. The average SPSS score was 16.31 (74.15%), with FEI Ai-hua, et al 2011 has the minimum SPSS of 12 (54.55%) and Garrow AP., et al 2014 has the maximum SPSS of 19 (86.36%). Nevertheless, dissecting the SPSS, shows that all the included trials failed to achieve 50% rate of the five points Jadad score (Jadad score ranged from 20% to 40%). Furthermore, 87.5% of the included trials scored zero for the Practitioner background score of (1) and only one study (Garrow AP., et al 2014) scored 1 (100%) and another study (Zhang C., et al, 2010) scored 0.5 (50%). However, the other scoring parameters of the novel SPSS tool were relatively on average well scored in the included reviews. Conclusion: This literature review showed that acupuncture treatment might be useful, effective and potentially safe complementary therapeutic tool in the management of DPN. However, these positive finding should be interpreted cautiously and conservatively, due to the fact that all included trials have high risks of bias. The heterogeneity of the included trials prevents us making a firm conclusion. The robustness of the results of the included trials could not be determined due to the fact that the majority of the included trials were of ‘inadequate methodology’ and low study population with multiple methodological and reporting biases. To ensure evidence-based clinical practice, further rigorous sham placebo-controlled, randomized trials are critically needed. These prospective trials need to be large scale studies and fully compliant with the CONSORT, STRICTA statements as well as the new quality assessment tool used in this study (SPSS) to ensure high power and robustness as well as the clinical implications of their results.