Non-pharmacological interventions for diabetic peripheral neuropathy: Are we winning the battle?

Abstract

Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy (DPN), such as nerve conduction studies, there is still a knowledge gap about the pathophysiology, and thus limited available interventions for symptom control and curtailing disease progression. The pharmacologic aspect of management is mainly centred on pain control, however, there are several important aspects of DPN such as loss of vibration sense, pressure sense, and proprioception which are associated with risks to lower limb health, which pharmacotherapy does not address. Furthermore, published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy, to reach a desired, however modest effect. Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes. In their study published in the World Journal of Diabetes on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters, Hoerder et al have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation. Although previous studies also support these findings, larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required. Overall, given the satisfactory safety profile and the positive results found in these studies, it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.

Keywords: Diabetic peripheral neuropathy, Diabetes mellitus, Pharmacotherapy, Acupuncture, Neuropathic pain, Nonpharmacological intervention

Core Tip: Even with multiple studies examining the pathobiology and management options for diabetic peripheral neuropathy (DPN), especially the neuropathic pain, there are still large knowledge gaps in our understanding to effectively address this important clinical problem. Acupuncture is an important nonpharmacological option for several chronic medical conditions including pain syndromes. In their study published in the World Journal of Diabetes, Hoerder et al provide us the reasonable efficacy of acupuncture for the management of DPN, though we need larger multi-center randomized clinical trials for using this therapeutic intervention to enable more evidence-based clinical decision-making.