Systematic review of treatments for diabetic peripheral neuropathy

Aim: To evaluate treatment options for neuropathic pain and sensory symptoms resulting from diabetic peripheral neuropathy of the feet. Methods: The databases PubMed, Embase and Web-of-Science were searched for randomized controlled trials, published in the period from database inception to 2 July 2015, that evaluated treatments for diabetic peripheral neuropathy of the feet with placebo or standard treatment as comparators. Participants in these trials included people with diabetes mellitus and diabetic peripheral neuropathy who were given any treatment for diabetic peripheral neuropathy. Risk of bias was assessed using the Delphi list of criteria. Data from the trials were extracted using standardized data extraction sheets by two authors independently. All analyses were performed using RevMan 5.2. In case of clinical homogeneity, statistical pooling was performed using a random effects model. Results: This review included 27 trials on pharmacological, non-pharmacological and alternative treatments. In the meta-analysis of trials of α-lipoic acid versus placebo, total symptom score was reduced by -2.45 (95% CI -4.52; -0.39) with 600 mg i.v. α-lipoic acid (three trials), and was reduced by -1.95 (95% CI -2.89; -1.01) with 600 mg oral α-lipoic acid (two trials). Significant improvements in diabetic peripheral neuropathy symptoms were found with opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage, but not with micronutrients, neurotrophic peptide ORG 2677 and photon stimulation therapy. Conclusion: In this review, we found that α-lipoic acid, opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage had significant beneficial results.