Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) in the treatment of diabetic neuropathy: A systematic review and meta-analysis of randomized controlled trials

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & Metabolic Syndrome-Clinical Research & Reviews Pub Date : 2025-03-01 DOI:10.1016/j.dsx.2025.103223

Alireza Azarboo , Parisa Fallahtafti , Amin Javidan , Negar Zareshahi , Hossein Souri Giglou , Shabboo Moayyed , Amirhossein Ghaseminejad-Raeini , Mahboobeh Hemmatabadi

{"title":"Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) in the treatment of diabetic neuropathy: A systematic review and meta-analysis of randomized controlled trials","authors":"Alireza Azarboo , Parisa Fallahtafti , Amin Javidan , Negar Zareshahi , Hossein Souri Giglou , Shabboo Moayyed , Amirhossein Ghaseminejad-Raeini , Mahboobeh Hemmatabadi","doi":"10.1016/j.dsx.2025.103223","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management.</div></div><div><h3>Methods</h3><div>Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I<sup>2</sup> statistics, with sensitivity analyses and publication bias evaluation.</div></div><div><h3>Results</h3><div>Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to −0.29, I<sup>2</sup> = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to −0.21, I<sup>2</sup> = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to −0.27, I<sup>2</sup> = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to −0.12, I<sup>2</sup> = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow.</div></div><div><h3>Conclusion</h3><div>FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration.</div></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":"19 3","pages":"Article 103223"},"PeriodicalIF":4.3000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1871402125000402","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management.

Methods

Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I² statistics, with sensitivity analyses and publication bias evaluation.

Results

Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to −0.29, I² = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to −0.21, I² = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to −0.27, I² = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to −0.12, I² = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow.

Conclusion

FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetes & Metabolic Syndrome-Clinical Research & Reviews ENDOCRINOLOGY & METABOLISM-

CiteScore

22.90

自引率

2.00%

发文量

248

审稿时长

51 days

期刊介绍： Diabetes and Metabolic Syndrome: Clinical Research and Reviews is the official journal of DiabetesIndia. It aims to provide a global platform for healthcare professionals, diabetes educators, and other stakeholders to submit their research on diabetes care. Types of Publications: Diabetes and Metabolic Syndrome: Clinical Research and Reviews publishes peer-reviewed original articles, reviews, short communications, case reports, letters to the Editor, and expert comments. Reviews and mini-reviews are particularly welcomed for areas within endocrinology undergoing rapid changes.