Acupuncture for diabetic peripheral neuropathy: A systematic review and Bayesian network meta-analysis

Diabetic peripheral neuropathy (DPN) has emerged as a global health challenge with increasing prevalence rates over the past 3 decades. Acupuncture has been increasingly utilized for the treatment of DPN in recent years. However, whether any specific acupuncture intervention should be considered a priority in the treatment of patients is still unclear.We aimed to summarize the latest evidence concerning the benefits and harms of acupuncture-related therapies to identify an optimal acupuncture intervention for DPN patients.

This systematic review and network meta-analysis searched databases from inception to October 2024 for randomized controlled trials (RCTs) evaluating acupuncture interventions in patients with DPN receiving mecobalamin therapy. We performed random-effects Bayesian network meta-analyses to synthesize evidence from eligible RCTs.

Our systematic search identified 1831 citations with 62 eligible RCTs involving 5942 participants. Electroacupuncture may be the most effective at improving motor nerve conduction velocity (mean difference [MD]: 10.65; 95% confidence interval [CI]: 4.6-16.7), followed by acupoint injection (AI) combined with traditional Chinese medicine (TCM), AI, herbal fumigation (HF), manual acupuncture (MA), MA combined with HF, and MA combined with moxibustion, with MDs of (10.37; 95% CI: 6.17-14.61), (4.67; 95% CI: 2.57-6.82), (4.72; 95% CI: 1.31-8.14), (3.36; 95% CI: 2.1-4.64), (5.93; 95% CI: 2.53-9.33), and (4.8; 95% CI: 1.69-7.94). AI may be the most effective at improving sensory nerve conduction velocity (MD: 3.94; 95% CI: 2.33-5.57), followed by acupoint injection combined with TCM, bloom needle, HF, MA, MA combined with HF, MA combined with moxibustion, and MA combined with TCM, with MDs of 8.69 (95% CI: 3.72-13.61), 5.6 (95% CI: 2.2-8.99), 4.58 (95% CI: 1.49-7.71), 3.72 (95% CI: 2.62-4.85), 25 (95% CI: 1.64-6.85), 3.58 (95% CI: 1.13-6.08), and 5.7 (95% CI: 4.24-7.17), with low certainty evidence.

Electroacupuncture may be the most effective therapy for improving motor nerve conduction function, and AI may be the best therapy for improving sensory nerve conduction function in patients with DPN.