Non-pharmacological interventions for diabetic peripheral neuropathy:Are we winning the battle?

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.

A summary of the evidence and evaluation of the effectiveness of nonpharmacological interventions for mild cognitive impairment

Objective: To summarize and evaluate the evidence of guidelines and systematic reviews(SRs) of nonpharmacological interventions for mild cognitive impairment(MCI) to support the development of future guidelines and clinical decisions for MCI patients.Methods: Scottish Intercollegiate Guideline Network(SIGN), National Institute for Health and Clinical Excellence(NICE), American Academy of Neurology(AAN), Registered Nurses Association of Ontario(RNAO), Web of Science, PubMed, Cochrane Library, CNAHL, VIP, China National Knowledge Infrastructure(CNKI), and Wanfang Database were searched for relevant publications, including guidelines and SRs, from January 2014 to March 2019. Two authors independently screened articles, extracted data, and assessed the publications for adherence to the inclusion criteria. Appraisal of Guidelines for Research and Evaluation(AGREE II) was used to assess the quality of the guidelines, and Assessment of Multiple Systematic Reviews(AMSTAR 2) was used to assess the quality of SRs. In addition, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) approach was used to evaluate the quality of outcomes.Results: Thirty-two articles were retrieved, including 1 guideline and 31 SRs. Fourteen SRs of physical exercise for MCI, six articles describing cognitive interventions, four articles describing acupuncture, and seven articles assessing dietary interventions(including four articles employing a Mediterranean diet, one article using vitamin B supplementation, and two articles assessing the effects of tea, coffee, and caffeine) were included. The quality of the articles was very low for 4(13%), low for 10(32%), and moderate for 17(55%).Conclusions: Based on the evidence available to date, nonpharmacological interventions may improve the current cognitive function of persons with MCI. In particular, physical exercise, cognitive interventions, and acupuncture exerted promising effects. However, due to the limited number and quality of the included publications, additional high-quality reviews are needed to further confirm.

Nonpharmacological pain management practices among nurses working in multiple centers in Saudi Arabia: A cross-sectional study

Objective:The aim of the study was to investigate the prevalence,and determinants,of nonpharmacological pain management practices among nurses in multiple settings.Materials and Methods:A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai’l,Saudi Arabia.Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers.Data analysis was performed using SPSS version 29.0.Results:Nonpharmacological pain management practices were found to be utilized“sometimes,”with a score of 2.89±0.48.Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment.Gender was the sole demographic factor significantly affecting the use of these techniques(P<0.001),with female nurses demonstrating higher utilization.Barriers to implementation varied based on the hours of recent pain management education(P=0.004),with prevalent barriers including nurse shortages,multiple responsibilities,heavy workloads,and nurse fatigue.Conclusion:The study reveals moderate utilization of nonpharmacological pain management approaches,primarily focusing on patient positioning and creating a calm environment.Female nurses exhibited higher adoption rates of these techniques.Barriers to implementation,such as nurse shortages and heavy workloads,were influenced by recent pain management education.Consequently,enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses.

Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults

BACKGROUND Although nonpharmacological interventions(NPI) for irritable bowel syndrome(IBS) have been applied clinically, their relative efficacy and safety are poorly understood.AIM To compare and rank different NPI in the treatment of IBS.METHODS Five electronic databases were searched from their inception to January 12, 2020. Data of included publications were analyzed using network meta-analysis(NMA). Quality of endpoints were assessed by tools of the Cochrane Handbook and the GRADEpro software. Pooled relative risk or standardized mean difference with their corresponding 95% confidence intervals were used for statistical analysis. Surface under the cumulative ranking curve(SUCRA) probability value was conducted to rank the examined interventions. Sensitivity analysis was performed to verify the robustness of results and test the source of heterogeneity.RESULTS Forty randomized controlled trials with 4196 participants were included in this NMA. Compared with routine pharmacotherapies and placebo, acupuncture and cognitive behavioral therapy(CBT) had better efficacy in relieving IBS symptoms. Based on the SUCRA values, acupuncture ranked first in improving overall clinical efficacy and avoiding adverse effects. CBT ranked first in lowering the scores of IBS symptom severity scale, self-rating anxiety scale and self-rating depression scale.CONCLUSION This study confirmed the efficacy and safety of NPI for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.

Cost effectiveness of nonpharmacological prevention programs for diabetes:A systematic review of trial-based studies

Trial-based economic value of prevention programs for diabetes is inexplicit.We aimed to review the cost-effectiveness of nonpharmacological interventions to prevent type-2 diabetes mellitus(T2DM)for high-risk people.Six electronic databases were searched up to March 2022.Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high-risk of T2DM were included.The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist.The primary outcome for synthesis was incremental cost-effectiveness ratios(ICER)for quality-adjusted life years(QALYs),and costs were standardized in 2022 US dollars.Narrative synthesis was performed,considering different types and delivery methods of interventions.Sixteen studies included five based on the US diabetes prevention program(DPP),six on non-DPP-based lifestyle interventions,four on health education,and one on screening plus lifestyle intervention.Compared with usual care,lifestyle interventions showed higher potential of cost-effectiveness than educational interventions.Among lifestyle interventions,DPP-based programs were less cost-effective(median of ICERs:$27,077/QALY)than non-DPP-based programs(median of ICERs:$1395/QALY)from healthcare perspectives,but with larger decreases in diabetes incidence.Besides,the cost-effectiveness of interventions was more possibly realized through the combination of different delivery methods.Different interventions to prevent T2DM in high-risk populations are both cost-effective and feasible in various settings.Nevertheless,economic evidence from low-and middle-income countries is still lacking,and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost-effective solution in such settings with limited resources.