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Meta-Analysis
. 2013 Oct 16;8(10):e76113.
doi: 10.1371/journal.pone.0076113. eCollection 2013.

Chinese herbal medicine for diabetic peripheral neuropathy: an updated meta-analysis of 10 high-quality randomized controlled studies

Chi-zi Hao  1 , Fan Wu, Lin Lu, Juan Wang, Yi Guo, Ai-ju Liu, Wei-jing Liao, Guo-qing Zheng
Affiliations
Meta-Analysis

Chinese herbal medicine for diabetic peripheral neuropathy: an updated meta-analysis of 10 high-quality randomized controlled studies

Chi-zi Hao et al. PLoS One. .

Abstract

Background: Diabetic peripheral neuropathy (DPN) is very common in people with diabetes. Chinese herbal medicine (CHM) therapy has been developed for DPN empirically over the years. The aim of this systematic review and meta-analysis was to assess the efficacy and safety of CHMs for patients suffering from DPN.

Methods: We performed a meta-analysis of randomized-controlled clinical trials (RCTs) evaluating the efficacy and safety of CHM on DPN. Six databases were searched up to November 2012. The primary outcome measures were the absolute values or changing of motor or sensory nerve conduction velocity (NCV), and the secondary outcome measurements were clinical symptoms improvements and adverse events. The methodological quality was assessed by Jadad scale and the twelve criteria recommended by the Cochrane Back Review Group.

Results: One hundred and sixty-three studies claimed RCTs. Ten studies with 653 individuals were further identified based on the Jadad score ≥ 3. These 10 studies were all of high methodological quality with a low risk of bias. Meta-analysis showed the effects of NCV favoring CHMs when compared with western conventional medicines (WCM) (P<0.05 or P<0.01). There is a significant difference in the total efficacy rate between the two groups (P<0.001). Adverse effects were reported in all of the ten included studies, and well tolerated in all patients with DPN.

Conclusion: Despite of the apparently positive findings and low risk of bias, it is premature to conclude the efficacy of CHMs for the treatment of DPN because of the high clinical heterogeneity and small sample sizes of the included studies. However, CHM therapy was safe for DPN. Further standardized preparation, large sample-size and rigorously designed RCTs are required.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA 2009 Flow Diagram.
Figure 2
Figure 2. Forest plot of median nerve conduction velocity of CHM for diabetic peripheral neuropathy.
Figure 3
Figure 3. Forest plot of peroneal nerve conduction velocity of CHM for diabetic peripheral neuropathy.
Figure 4
Figure 4. Funnel plot of median nerve conduction velocity of CHM for diabetic peripheral neuropathy.
Figure 5.Funnel
Figure 5.Funnel. plot of peroneal nerve conduction velocity of CHM for diabetic peripheral neuropathy.
Figure 6
Figure 6. Forest plot of efficacy rate of CHM for diabetic peripheral neuropathy.
Figure 7
Figure 7. Funnel plot of efficacy rate of CHM for diabetic peripheral neuropathy.
See this image and copyright information in PMC

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