Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2024; 15(4): 579-585
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.579
Non-pharmacological interventions for diabetic peripheral neuropathy: Are we winning the battle?
Dania Blaibel, Cornelius James Fernandez, Joseph M Pappachan
Dania Blaibel, Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Cornelius James Fernandez, Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Author contributions: Blaibel D substantially contributed to the initial drafting of the work by performing the literature search, interpretation of relevant literature, with some broad guidance from Fernandez CJ and Pappachan JM and made revisions; Fernandez CJ also contributed to figure preparation for the manuscript; Pappachan JM conceptualised the idea, supervised the whole drafting, and revision process of the article critically for important intellectual content; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Academic Editor, Consultant Endocrinologist, Professor, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Received: November 29, 2023
Peer-review started: November 29, 2023
First decision: January 16, 2024
Revised: January 18, 2024
Accepted: March 4, 2024
Article in press: March 4, 2024
Published online: April 15, 2024

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.