Diabetic peripheral neuropathy (DPN) is a common and disabling complication of diabetes. Many patients experience pain, numbness, and impaired quality of life, while currently available treatments may have limited benefit or cause adverse effects. Electroacupuncture (EA) may provide a safe, non-pharmacological treatment option, but further clinical evidence is needed.
The purpose of this study is to evaluate the efficacy and potential mechanisms of low-frequency (2 Hz) electroacupuncture in patients with DPN. In this prospective, randomized, sham-controlled trial, participants will be assigned to either a verum 2 Hz EA group or a sham EA group. The study will assess nerve conduction velocity, pain intensity, serum neurotrophic factors and inflammatory cytokines, and quality of life.
This study is intended to provide clinical evidence on the use of low-frequency EA for DPN and to examine whether its effects are related to neurotrophic and inflammatory pathways.
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1.Peripheral neuropathy due to other etiologies (e.g., hypothyroidism, alcohol, medications, hereditary causes), presence of limb ulcers or gangrene, or a history of skin ulceration or poorly healing lesions.
Parallel
EA
Other interventionDisposable sterile acupuncture needles (Hwato brand) in sizes of 0.18 mm × 25 mm and 0.25 mm × 40 mm were used. Following skin disinfection with 75% alcohol swabs, needles were inserted at selected acupoints to elicit a deqi sensation, characterized by local soreness, numbness, or distension reported by the participant.
Sham EA
Other interventionSuperficial insertion to a depth of approximately 1-2 mm was performed at these sites using Hwato brand disposable sterile acupuncture needles (0.18 mm × 25 mm). A Hwato SDZ-IIB electronic acupuncture stimulator with deliberately impaired connecting leads was attached to the needles at the sham sites. After the device was turned on and the frequency and intensity parameters were visibly set on the display screen, participants underwent a 30-minute needle retention period. Although the stimulator screen remained active, no actual electrical current was delivered to the needles throughout the session.
Lower limb nerve conduction velocity
Lower limb nerve conduction velocity (NCV) will be measured at baseline and at the end of the 6-week intervention. Assessments will include motor NCV and sensory NCV of the bilateral common peroneal nerves and tibial nerves.
Overall clinical response rate
Overall clinical response rate will be assessed at the end of the 6-week treatment period. Treatment efficacy will be categorized into three levels: marked effective, effective, and ineffective. Marked effective will be defined as significant subjective symptom relief accompanied by an increase in nerve conduction velocity (NCV) of ≥5 m/s on electromyography, or recovery to near-normal levels. Effective will be defined as subjective clinical improvement with an NCV increase of \<5 m/s. Ineffective will be defined as no significant improvement in clinical symptoms, tendon reflexes, sensory perception, or NCV. The overall clinical response rate will be calculated as (number of marked effective cases + number of effective cases) / total number of participants × 100%.
Visual Analog Scale score
The Visual Analog Scale (VAS) will be used to assess pain, numbness, and burning sensations. Scores range from 0 to 10, with higher scores indicating more severe symptoms.
Toronto Clinical Scoring System score
The Toronto Clinical Scoring System (TCSS) will be used to assess the severity of diabetic peripheral neuropathy. The TCSS is a 19-point composite scale consisting of symptom, reflex, and sensory test components. Higher scores indicate greater severity of neuropathy.
Diabetes Quality of Life scale score
The Diabetes Quality of Life (DQoL) scale will be used to assess quality of life. In the version used in this study, the total score ranges from 27 to 135, with lower scores indicating better quality of life.
Serum nerve growth factor concentration
Fasting peripheral venous blood samples will be collected in the morning at each assessment time point. Serum nerve growth factor (NGF) concentration will be measured using enzyme-linked immunosorbent assay (ELISA).
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The First Affiliated Hospital of Zhejiang Chinese Medical University
Lead sponsor
The Third Affiliated hospital of Zhejiang Chinese Medical University
Collaborator
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