BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that...BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.AIM To investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.METHODS The acupuncture in DPN(ACUDPN)study was a two-armed,randomized,controlled,parallel group,open,multicenter clinical trial.Patients were randomized in a 1:1 ratio into two groups:The acupuncture group received 12 acupuncture treatments over 8 wk,and the control group was on a waiting list during the first 16 wk,before it received the same treatment as the other group.Both groups received routine care.Outcome parameters were evaluated after 8,16 and 24 wk and included neurological scores,such as an 11-point numeric rating scale(NRS)11 for hypesthesia,neuropathic pain symptom inventory(NPSI),neuropathy deficit score(NDS),neuropathy symptom score(NSS);nerve conduction studies(NCS)were assessed with a handheld point-of-care device.RESULTSSixty-two participants were included.The NRS for numbness showed a difference of 2.3(P<0.001)in favor of theacupuncture group,the effect persisted until week 16 with a difference of 2.2(P<0.001)between groups and 1.8points at week 24 compared to baseline.The NPSI was improved in the acupuncture group by 12.6 points(P<0.001)at week 8,the NSS score at week 8 with a difference of 1.3(P<0.001);the NDS and the TNSc score improvedfor the acupuncture group in week 8,with a difference of 2.0 points(P<0.001)compared to the control group.Effects were persistent in week 16 with a difference of 1.8 points(P<0.05).The NCS showed no meaningfulchanges.In both groups only minor side effects were reported.CONCLUSION Study results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reductionin neurological deficits.No serious adverse events were recorded and the adherence to treatment was high.Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirmthe results.展开更多
Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited availab...Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited available in-terventions for symptom control and curtailing disease progression.The pharma-cologic aspect of management is mainly centred on pain control,however,there are several important aspects of DPN such as loss of vibration sense,pressure sense,and proprioception which are associated with risks to lower limb health,which pharmacotherapy does not address.Furthermore,published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy,to reach a desired,however modest effect.Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes.In their study published in the World Journal of Diabetes on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters,Hoerder et al have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation.Although previous studies also support these findings,larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required.Overall,given the satisfactory safety profile and the positive results found in these studies,it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.展开更多
Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming...Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013：221 cases showed symptoms of peripheral neuropathy （symptomatic group） and 279 cases had no symptoms of peripheral impairment （asymptomatic group）. One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases （71.6%）, among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.展开更多
Objective:To observe the clinical effects of acupuncture for diabetic peripheral neuropathy.Methods:Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the ...Objective:To observe the clinical effects of acupuncture for diabetic peripheral neuropathy.Methods:Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes,acupuncture was used in the treatment group,and inositol was orally administered in the control group.During a 3-month treatment,changes in the symptoms were observed.Results:In the treatment group,16 cases were markedly relieved,12 cases improved,and 4 cases failed,with a total effective rate of 87.5%.In the control group,7 cases were markedly relieved,14 cases improved and 12 cases failed,with a total effective rate of 63.6%.There was a significant difference in the total effective rate between the 2 groups(P<0.05) .Conclusion:Acupuncture may show good effects for diabetic peripheral neuropathy.展开更多
Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of D...Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1,2019.Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation,methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses(PRISMA),assessment of multiple systematic review 2(AMSTAR 2)and grading of recommendations assessment,development and evaluation(GRADE).Results:Ten systematic reviews were included,involving 11 outcome measures.According to PRISMA,6 items were sufficiently reported while 1 item was not;AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation;according to GRADE,of the 30 clinical evidences,only 5 were graded moderate while the remained were graded low or extremely low.Descriptive analysis showed that acupuncture can significantly improve DPN symptoms,accelerate the conduction velocities of sensory and motor nerves,and up-regulate the content of plasma nitric oxide(NO),while the adverse reaction rate was low.Conclusion:Acupuncture can produce satisfactory clinical efficacy in treating DPN,but the existing problems,such as low-quality evidence,unitary outcome measures,poor methodological quality of systematic reviews and nonstandard reporting,need to be treated cautiously;meanwhile,more high-quality clinical trials are required to elevate the level of evidence.展开更多
Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patie...Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patients were randomized into western medication group,acupuncture group,and combination group,with 31 cases in each.The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets.The patients in acupuncture group were treated with acupuncture,and the acupoints were selected according to the symptoms.The needles were retained for 30 min,once a day.The patients in combination group were treated with both western medication and acupuncture,specific methods as the above.The treatments were for 18 days in succession in all of three group.The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve,as well as the changes of symptoms and signs of patients were observed before and after treatment.The clinical effect was evaluated.Results:After treatment,the median nerve MNCV in the three groups,the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups,and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment,with significantly statistical differences(all P<0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group,with significantly statistical differences(all P<0.05).After treatment,the number of patients in the three groups with the symptoms and signs was lower than that of before treatment.The effective rate in combination group was 96.8%(30/31),higher than those of western medication group,74.2%(23/31),and acupuncture group,83.8%(26/31),with significantly statistical differences(both P<0.05).Conclusion:Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients,with a better effect than those of western medication and simple acupuncture.展开更多
The pathogenesis of diabetic peripheral neuropathy(DPN)has not been fully elucidated,and treatment options are limited.Currently,the main strategies for treating DPN are strict glycemic control and symptomatic pain re...The pathogenesis of diabetic peripheral neuropathy(DPN)has not been fully elucidated,and treatment options are limited.Currently,the main strategies for treating DPN are strict glycemic control and symptomatic pain relief.In this editorial,we comment on an article by Li et al,which suggested that modulating the gut microbiota using traditional Chinese medicine(TCM)may be a promising strategy for alleviating DPN symptoms.The regulation of the gut microbiota has received widespread attention in the study of various diseases.TCM can parti-cipate in the regulation of gut microbiota through multiple mechanisms,and this regulatory effect can alleviate the clinical symptoms of DPN.We briefly analyzed the promise of the gut microbiota in the early diagnosis,treatment,and clinical efficacy of TCM for DPN.The gut microbiota has potential value at multiple no-des in the occurrence and progression of DPN.展开更多
Objective To compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus.Methods Sixty patie...Objective To compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus.Methods Sixty patients were randomly divided into an acupuncture group(31 cases)and a medication group(29 cases).Patients in the two groups received basic treatment to control blood sugar within a safe range.On this basis,patients in the acu-展开更多
文摘BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of diabetes mellitus and can lead to serious complications.Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.AIM To investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.METHODS The acupuncture in DPN(ACUDPN)study was a two-armed,randomized,controlled,parallel group,open,multicenter clinical trial.Patients were randomized in a 1:1 ratio into two groups:The acupuncture group received 12 acupuncture treatments over 8 wk,and the control group was on a waiting list during the first 16 wk,before it received the same treatment as the other group.Both groups received routine care.Outcome parameters were evaluated after 8,16 and 24 wk and included neurological scores,such as an 11-point numeric rating scale(NRS)11 for hypesthesia,neuropathic pain symptom inventory(NPSI),neuropathy deficit score(NDS),neuropathy symptom score(NSS);nerve conduction studies(NCS)were assessed with a handheld point-of-care device.RESULTSSixty-two participants were included.The NRS for numbness showed a difference of 2.3(P<0.001)in favor of theacupuncture group,the effect persisted until week 16 with a difference of 2.2(P<0.001)between groups and 1.8points at week 24 compared to baseline.The NPSI was improved in the acupuncture group by 12.6 points(P<0.001)at week 8,the NSS score at week 8 with a difference of 1.3(P<0.001);the NDS and the TNSc score improvedfor the acupuncture group in week 8,with a difference of 2.0 points(P<0.001)compared to the control group.Effects were persistent in week 16 with a difference of 1.8 points(P<0.05).The NCS showed no meaningfulchanges.In both groups only minor side effects were reported.CONCLUSION Study results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reductionin neurological deficits.No serious adverse events were recorded and the adherence to treatment was high.Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirmthe results.
文摘Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy(DPN),such as nerve conduction studies,there is still a knowledge gap about the pathophysiology,and thus limited available in-terventions for symptom control and curtailing disease progression.The pharma-cologic aspect of management is mainly centred on pain control,however,there are several important aspects of DPN such as loss of vibration sense,pressure sense,and proprioception which are associated with risks to lower limb health,which pharmacotherapy does not address.Furthermore,published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy,to reach a desired,however modest effect.Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes.In their study published in the World Journal of Diabetes on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters,Hoerder et al have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation.Although previous studies also support these findings,larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required.Overall,given the satisfactory safety profile and the positive results found in these studies,it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.
基金supported by the Science and Research Fund of Academic Department in Yunnan Province in China,No.2011C08
文摘Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013：221 cases showed symptoms of peripheral neuropathy （symptomatic group） and 279 cases had no symptoms of peripheral impairment （asymptomatic group）. One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases （71.6%）, among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.
文摘Objective:To observe the clinical effects of acupuncture for diabetic peripheral neuropathy.Methods:Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes,acupuncture was used in the treatment group,and inositol was orally administered in the control group.During a 3-month treatment,changes in the symptoms were observed.Results:In the treatment group,16 cases were markedly relieved,12 cases improved,and 4 cases failed,with a total effective rate of 87.5%.In the control group,7 cases were markedly relieved,14 cases improved and 12 cases failed,with a total effective rate of 63.6%.There was a significant difference in the total effective rate between the 2 groups(P<0.05) .Conclusion:Acupuncture may show good effects for diabetic peripheral neuropathy.
文摘Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1,2019.Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation,methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses(PRISMA),assessment of multiple systematic review 2(AMSTAR 2)and grading of recommendations assessment,development and evaluation(GRADE).Results:Ten systematic reviews were included,involving 11 outcome measures.According to PRISMA,6 items were sufficiently reported while 1 item was not;AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation;according to GRADE,of the 30 clinical evidences,only 5 were graded moderate while the remained were graded low or extremely low.Descriptive analysis showed that acupuncture can significantly improve DPN symptoms,accelerate the conduction velocities of sensory and motor nerves,and up-regulate the content of plasma nitric oxide(NO),while the adverse reaction rate was low.Conclusion:Acupuncture can produce satisfactory clinical efficacy in treating DPN,but the existing problems,such as low-quality evidence,unitary outcome measures,poor methodological quality of systematic reviews and nonstandard reporting,need to be treated cautiously;meanwhile,more high-quality clinical trials are required to elevate the level of evidence.
基金Zhangjiakou Science and Technology Research Plan:1321111D。
文摘Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patients were randomized into western medication group,acupuncture group,and combination group,with 31 cases in each.The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets.The patients in acupuncture group were treated with acupuncture,and the acupoints were selected according to the symptoms.The needles were retained for 30 min,once a day.The patients in combination group were treated with both western medication and acupuncture,specific methods as the above.The treatments were for 18 days in succession in all of three group.The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve,as well as the changes of symptoms and signs of patients were observed before and after treatment.The clinical effect was evaluated.Results:After treatment,the median nerve MNCV in the three groups,the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups,and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment,with significantly statistical differences(all P<0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group,with significantly statistical differences(all P<0.05).After treatment,the number of patients in the three groups with the symptoms and signs was lower than that of before treatment.The effective rate in combination group was 96.8%(30/31),higher than those of western medication group,74.2%(23/31),and acupuncture group,83.8%(26/31),with significantly statistical differences(both P<0.05).Conclusion:Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients,with a better effect than those of western medication and simple acupuncture.
基金Supported by National Natural Science Foundation of China,No.82104862Scientific Research Project Foundation of Zhejiang Chinese Medical University,No.2023FSYYZZ01 and No.2023RCZXZK49Scientific Research Project Foundation of Zhejiang Association of Rehabilitation Medicine,No.ZKKY2024018.
文摘The pathogenesis of diabetic peripheral neuropathy(DPN)has not been fully elucidated,and treatment options are limited.Currently,the main strategies for treating DPN are strict glycemic control and symptomatic pain relief.In this editorial,we comment on an article by Li et al,which suggested that modulating the gut microbiota using traditional Chinese medicine(TCM)may be a promising strategy for alleviating DPN symptoms.The regulation of the gut microbiota has received widespread attention in the study of various diseases.TCM can parti-cipate in the regulation of gut microbiota through multiple mechanisms,and this regulatory effect can alleviate the clinical symptoms of DPN.We briefly analyzed the promise of the gut microbiota in the early diagnosis,treatment,and clinical efficacy of TCM for DPN.The gut microbiota has potential value at multiple no-des in the occurrence and progression of DPN.
文摘Objective To compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus.Methods Sixty patients were randomly divided into an acupuncture group(31 cases)and a medication group(29 cases).Patients in the two groups received basic treatment to control blood sugar within a safe range.On this basis,patients in the acu-
