Efficacy and safety of Buyang Huanwu Decoction combined with α-lipoic acid for diabetic peripheral neuropathy: a systematic review with in-depth heterogeneity deconstruction and methodological appraisal - Summary - MDSpire
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Efficacy and safety of Buyang Huanwu Decoction combined with α-lipoic acid for diabetic peripheral neuropathy: a systematic review with in-depth heterogeneity deconstruction and methodological appraisal
To evaluate the efficacy and safety of BYHWD+ALA for DPN and to clarify sources of heterogeneity using a multi-tiered framework.
Key Findings:
Twelve RCTs with 926 patients were included.
BYHWD+ALA significantly improved overall response rate (RR = 1.24, 95% CI 1.17–1.32) and TCM syndrome scores (SMD = -0.76, 95% CI -0.98 to -0.54).
High heterogeneity was observed for nerve conduction velocity (NCV) measurements (I² > 92%).
Only peroneal nerve motor NCV showed a robust improvement trend (SMD = 1.01, 95% CI 0.48–1.54).
Oxidative stress markers trended favorably; no differences in HbA1c or adverse events between groups.
Interpretation:
BYHWD+ALA safely improves subjective DPN symptoms, but the evidence for NCV is too heterogeneous to draw reliable conclusions, impacting clinical decision-making.
Limitations:
High heterogeneity in NCV measurements.
Non-standardized NCV measurement protocols.
Complex intervention-patient matching may introduce variability in treatment effects.
Conclusion:
This study provides a methodological framework for deconstructing heterogeneity and guides future standardized research.
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