Zhongguo quanke yixue (Nov 2022)
Efficacy and Safety of the Five Commonly Used External Therapies of TCM Combined with Conventional Western Medicine in Treating Diabetic Peripheral Neuropathy: a Bayesian Network Meta-analysis
Abstract
Background Diabetic peripheral neuropathy (DPN) is one of the common complications in diabetic patients, and TCM external therapies represented by acupuncture has some advantages in treating DPN, but what combination of TCM external therapies and conventional Western medicine has the best efficacy in treating DPN is still lacking evidence-based medical studies. Objective To evaluate the efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN by Bayesian Network Meta-analysis. Methods The five commonly used external therapies of TCM confirmed by pre-survey were acupuncture, foot bath, acupoint massage, acupoint injection and moxibustion, respectively. The Cochrane Library, Web of Science, PubMed, SinoMed, VIP, Wanfang Data and CNKI were searched by computer from their inception to December 29th, 2020, to screen randomized controlled trials (RCTs) about efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN. RevMan 5.3, Stata 15.0 and ADDIS 1.16.6 software were used for plotting and data analysis. Results A total of 44 RCTs were enrolled, including 3 471 patients with DPN. Bayesian network Meta-analysis showed that the five commonly used external therapies of TCM combined with Western medicine were all superior to conventional Western medicine alone in improving overall efficacy rate, of which acupuncture had the best effect〔OR=0.20, 95%CI (0.11, 0.36) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve motor conduction velocity (MNCV) , with acupoint injection being the most effective〔MD=-4.50, 95%CI (-5.91, -3.11) 〕. The five commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve sensory conduction velocity (SNCV) , in which moxibustion had the best effect〔MD=-9.03, 95%CI (-12.59, -5.47) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone, with moxibustion having the best effect〔MD=-6.34, 95%CI (-9.31, -3.30) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional western medicine were all superior to conventional Western medicine alone in improving SNCV of the common peroneal nerve, with acupuncture showing the best efficacy〔MD=-5.70, 95%CI (-8.03, -3.31) 〕. Conclusion Acupuncture combined with conventional Western medicine is recommended preferentially in treating DPN based on available literature evidence, especially in improving overall efficacy rate and SNCV of the common peroneal nerve, but more high-quality studies are still needed for further validation.
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