Acupoint prescriptions, treatment protocol and outcome evidence for acupuncture in diabetic peripheral neuropathy: A scoping review of clinical studies

Introduction

Acupuncture is a complementary therapy for diabetic peripheral neuropathy (DPN). This scoping review systematically collect clinical studies using acupuncture for the treatment of DPN to analyze and summarize acupuncture point prescriptions, treatment protocols, and outcome indicators regarding clinical trials of acupuncture for DPN. The results will help guide the selection of future clinical protocols.

Methods

Eight databases were searched from their inception to March 1, 2023, including PubMed, Excerpt Medica Database (EMBASE), Web of Science, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI), China Biology Medicine disk (CBM disk), Wan Fang, and Chinese Scientific Journal Database (VIP). Demographic characteristics of study participants, patients, treatment details, acupuncture prescriptions, and outcome indicators were screened and extracted.

Results

A total of 219 clinical studies were included, and the number of published studies showed a year-on-year increase. Two hundred eleven studies (96.34%) were conducted in China. One hundred fifty one (68.95%) were conducted in Traditional Chinese Medicine (TCM) hospitals. Two hundred and six (94.06%) studies were randomized controlled trials (RCTs) that treated patients with different clinical symptoms of DPN in 17,945 patients. The primary intervention was manual acupuncture treatment, most commonly with stainless steel needles (φ0.35 mm × 40 mm) left in place for more than 30 minutes. Acupuncture points SP6 and ST36 combined were applied most frequently, and the five points with frequencies over 100 were ST36, SP6, LI11, LI4, and GB34. The outcome indicators of acupuncture for DPN were mainly nerve conduction velocity, effectiveness rating scale, and efficiency. Adverse events were reported in only a few studies and mainly included nausea, pain, and diarrhea.

Conclusions

This review provides evidence on treatment protocols, point prescriptions, and outcome metrics for acupuncture for DPN. However, the low quality of the study designs included in the clinical literature resulted in a degree of selection bias in the findings, which still needs to be validated by high-quality clinical trials. Future studies should be designed as more rigorous multicenter, large-sample randomized controlled trials to improve the accuracy and consistency of the effectiveness evaluation of acupuncture for DPN and enrich the standardized clinical treatment protocols for DPN.