Five Traditional Chinese Medicine External Treatment Methods Combined with Mecobalamin for Diabetic Peripheral Neuropathy: A Network Meta-Analysis

BACKGROUND: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. Traditional Chinese medicine (TCM) external treatment has been widely used in China as adjunctive treatment, and some small sample clinical studies have proved its effectiveness. However, due to the limited number of studies, we used network meta-analysis to compare the effectiveness of 5 commonly used external treatment methods of traditional Chinese medicine in the treatment of diabetic peripheral neuropathy. METHODS: We searched PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, CBM, WanFang Knowledge Service Platform, and VIP databases and collected and screened randomised controlled trials on the external treatment of traditional Chinese medicine combined with mecobalamin in the treatment of DPN according to the inclusion and exclusion criteria. The search period was from 2011 to May 2021. The quality of included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. The outcome indicators are Toronto score, median nerve sensory conduction velocity, and median nerve motor conduction velocity. RESULTS: A total of 22 publications were included in the study. The results of the network meta-analysis showed that acupuncture combined with mecobalamin was superior to other TCM external treatments combined with mecobalamin in terms of decreasing the Toronto score (MD = −2.8, 95% CI: −5.2∼−0.49), improving median nerve sensory conduction velocity (MD = 3.6, 95% CI: 2.4∼4.9), and median nerve motor conduction velocity (MD = 4.5, 95% CI: 2.6∼6.5). The SUCRA value and probability ranking chart showed that among the three outcome indicators, acupuncture combined with mecobalamin was the best, followed by acupoint injection combined with mecobalamin. CONCLUSION: In this network meta-analysis, acupuncture combined with mecobalamin shows the best results in the treatment of DPN, followed by acupoint injection combined with mecobalamin.