---
title: "Diabetic neuropathy"
url: "https://acuiq.com/wiki/evidence/diabetic-neuropathy"
updated: 2026-10-11
last_verified: 2026-10-11
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-11"
reading_minutes: 10
sources: 18
---

# Diabetic neuropathy

_What the Cochrane review of neuropathic pain, later reviews, trials of acupuncture against sham and usual care, and the ADA, AAN and NICE guidelines report on diabetic peripheral neuropathy._

Diabetic peripheral neuropathy is nerve damage caused by diabetes, felt mostly as numbness, tingling, burning or pain that starts in the feet. A [2025 review](https://doi.org/10.1007/s11916-025-01386-z) by Lan and colleagues gives it as affecting up to half of all people with diabetes. When pain is the main complaint it is called painful diabetic neuropathy, and most trials of acupuncture enrol people with pain; others measure numbness or nerve conduction, the speed at which a nerve carries a signal. Cochrane has not published a review of acupuncture for diabetic neuropathy alone. Its review of neuropathic pain in general, the reviews that followed it and the trials below disagree on how large any effect over sham acupuncture is, and none of the guidelines written for diabetic or neuropathic pain names acupuncture. Electroacupuncture, in which a small current is passed between needles, is described in [Electroacupuncture](/wiki/techniques/electroacupuncture).

## The Cochrane review

The nearest Cochrane review is [Acupuncture for neuropathic pain in adults](https://doi.org/10.1002/14651858.cd012057.pub2) (Ju and colleagues, 2017), searched to February 2017. It included 6 trials with 462 people, and 5 of them, with 358 people, enrolled people with diabetic peripheral neuropathy; the sixth studied neuropathy after chemotherapy. All 6 used manual acupuncture for 8 to 12 weeks, and all were at high risk of bias because participants and practitioners knew who had acupuncture.

- **Against sham.** One trial of 45 people compared acupuncture with sham acupuncture and found no clear difference in pain: 0.4 points lower on a 0 to 10 scale, with a 95% confidence interval from 1.83 lower to 1.03 higher (very low quality evidence). Neither group’s average pain fell to mild.
- **Against drugs.** In 3 trials with 209 people, against mecobalamin (a form of vitamin B12) with nimodipine, or against inositol, fewer people in the acupuncture groups had no clinical response (risk ratio 0.25). These trials reported no pain scores and no adverse events.

The authors rated the overall evidence very low quality and concluded that there was insufficient evidence to support or refute acupuncture for neuropathic pain in general or for any specific condition. The review recorded 5 ongoing trials and 7 awaiting classification. No later version has appeared in the Cochrane Library.

## Later reviews

Many trials in these reviews report a “total effective rate”, the share of patients whose symptoms improved by a set amount. A risk ratio (RR) of 1.42 means the effective rate was 42% higher with acupuncture. A standardised mean difference (SMD) is the gap between groups in units of the spread of scores.

| Review | Trials and people | Comparisons | Main pooled result | Certainty |
| --- | --- | --- | --- | --- |
| [Liu 2024](https://doi.org/10.3389/fneur.2024.1402458), painful neuropathy, searched to April 2023 | 36 trials, 2,739 people | Sham, drugs and usual care, pooled | Effective rate RR 1.42 (21 trials); pain SMD 1.27 lower (23 trials); no difference in adverse events | Not graded; publication bias found on four outcomes |
| [Lan 2025](https://doi.org/10.1007/s11916-025-01386-z), searched to September 2024 | 14 trials, 1,169 people | Sham, usual care and drugs, analysed separately | Against sham, pain 1.44 points lower on a 0 to 10 scale; against sham or usual care, 1.22 points lower on the 19-point Toronto Clinical Scoring System | Low (GRADE) |
| [Lin 2025](https://doi.org/10.1097/md.0000000000043796), network meta-analysis, searched to October 2024 | 62 trials, 5,942 people, all also taking mecobalamin | Acupuncture techniques ranked against each other and mecobalamin alone | Electroacupuncture ranked first for motor nerve conduction velocity, acupoint injection for sensory | Low |

Lan and colleagues, at McMaster University in Hamilton, Canada, and in Chengdu, kept each comparison apart. Against sham, they modelled that the share of people reaching an improvement of 1.5 points, the smallest difference patients notice, would be 45 percentage points higher with acupuncture. They found little or no difference from sham or usual care in physical or mental functioning or in adverse events, and low certainty evidence of less pain than with amitriptyline or pregabalin. Liu and colleagues, at Guangzhou University of Chinese Medicine, pooled sham, drug and usual-care controls and did not rate certainty. Among the points their trials used most often were [`ST36`](/points/ST36) (Zusanli) and [`SP06`](/points/SP06) (Sanyinjiao).

An [overview of 18 meta-analyses](https://doi.org/10.3389/fneur.2024.1420510) by Jiang and colleagues, searched to December 2023, rated the reviews themselves on AMSTAR-2, a checklist for how a systematic review was conducted: 4 moderate, 7 low and 7 critically low. Of the outcomes comparing acupuncture with conventional drugs, it rated 4 moderate certainty and the other 35 low or critically low. It found that, against conventional drugs, acupuncture alone or added to drugs improved the effective rate and nerve conduction velocity.

## Trials against sham

A [2014 pilot trial](https://doi.org/10.1136/acupmed-2013-010495) by Garrow and colleagues in the UK, the sham trial in the Cochrane review, gave 45 people with painful diabetic neuropathy a 10-week course of real or sham acupuncture at five points on each leg: [`LV03`](/points/LV03) (Taichong), [`KD03`](/points/KD03) (Taixi), `SP06`, [`SP10`](/points/SP10) (Xuehai) and `ST36`. Pain on a 0 to 100 scale fell by 15 points in the real acupuncture group with little change with sham, but the between-group differences on the LANSS pain scale and a sleep scale were not significant. The authors reported that acupuncture was practical and well tolerated in this group and asked for larger trials.

The [ACUDIN trial](https://doi.org/10.1111/1753-0407.13130) by Meyer-Hamme and colleagues at the University Medical Center Hamburg-Eppendorf, published in 2021, randomised 180 adults with type 2 diabetes and confirmed neuropathy to 10 weekly sessions of needle acupuncture, laser acupuncture or placebo laser, at [`ST34`](/points/ST34) (Liangqiu), Bafeng (EX-LE10) and Qiduan (EX-LE12) on both legs. Its primary outcome was a nerve conduction measure, the sural sensory nerve action potential, and 172 people completed. The authors found that the sural action potential and the conduction velocities of the sural and tibial nerves improved more with needle acupuncture than with placebo laser after 10 sessions. The control was a placebo laser rather than a sham needle, and the authors describe the trial as partially double-blinded.

A [single-blind trial in Sabzevar, Iran](https://doi.org/10.1007/s40200-023-01314-1), by Zardosht and colleagues, published in 2023, gave 60 people seven weekly sessions of real or sham acupuncture alongside routine treatment. Pain and fatigue scores did not differ between groups at any visit, and the confidence interval for pain included effects favouring sham. A [2025 pilot trial in Mexico City](https://doi.org/10.1186/s12906-025-05135-y) by Pérez Hernández and colleagues gave 18 people 16 sessions of electroacupuncture or sham electroacupuncture over 8 weeks. Pain on a 0 to 10 scale fell in the electroacupuncture group while scores on the DN-4 neuropathic pain questionnaire did not change in either group, and the authors called the findings hypothesis-generating. [Sham acupuncture](/wiki/research/sham-acupuncture) covers why a sham control is hard to make inert.

## Trials against usual care

A [2019 trial](https://doi.org/10.1093/pm/pnz117) by Chao and colleagues at the University of California, San Francisco, randomised 40 people with painful diabetic neuropathy at a public safety-net hospital to usual care or usual care plus group acupuncture once or twice a week for 12 weeks. Weekly pain fell by 2.06 points more on a 0 to 10 scale with acupuncture during the 12 weeks, but the difference was not maintained at week 18, 6 weeks after treatment ended. Once- and twice-weekly sessions did not differ.

The [ACUDPN trial](https://doi.org/10.3390/jcm12062103) by Dietzel and colleagues at the Charité in Berlin, published in 2023, randomised 62 people with type 2 diabetes and neuropathy in the legs to 12 sessions over 8 weeks or a waiting list, with routine care in both groups. Overall complaints on a visual analogue scale were 24.7 points lower in the acupuncture group, and pain and quality-of-life scores also improved; side effects were minor and transient. A [second report](https://doi.org/10.4239/wjd.v14.i12.1813) on its neurological outcomes found numbness 2.3 points lower on a 0 to 10 scale at week 8, but nerve conduction measured with a handheld device did not change meaningfully. The trial was open, with no sham arm, and the authors called for sham-controlled trials.

## What guidelines say

The American Diabetes Association’s [Standards of Care in Diabetes–2026](https://doi.org/10.2337/dc26-S012), section 12, recommends gabapentinoids, serotonin–noradrenaline reuptake inhibitors, tricyclic antidepressants and sodium channel blockers as initial drug treatment for neuropathic pain in diabetes (recommendation 12.22, grade A). The section does not mention acupuncture. The Standards are revised every year.

The American Academy of Neurology’s [guideline on oral and topical treatment of painful diabetic polyneuropathy](https://doi.org/10.1212/WNL.0000000000013038), by Price and colleagues, was published in December 2021 and replaced the AAN’s 2011 guideline. For patients who prefer topical, nontraditional or nonpharmacologic treatment, it says providers may offer cognitive behavioural therapy, exercise, tai chi or mindfulness among others (level C); it does not name acupuncture. The AAN [reaffirmed the guideline](https://www.aan.com/Guidelines/home/GuidelineDetail/1055) on 8 February 2025.

NICE’s [CG173](https://www.nice.org.uk/guidance/cg173/chapter/Recommendations), on neuropathic pain in adults in non-specialist settings, covers only drug treatment. Published in November 2013 and last updated in September 2020, it offers a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment. NICE’s [NG193](https://www.nice.org.uk/guidance/ng193/chapter/Recommendations) of April 2021 says a single course of acupuncture may be considered for chronic primary pain, which no underlying condition adequately accounts for. For pain that a condition does account for, it points to that condition’s own guideline and names neuropathic pain among them, so its acupuncture recommendation covers chronic primary pain rather than pain from diabetic neuropathy. [Chronic pain](/wiki/evidence/chronic-pain) reports the trials behind that recommendation.

## What the reviews could not settle

The estimates against sham disagree. The one sham trial in the Cochrane review, with 45 people, found no clear difference in pain, while Lan’s 2025 review pooled a larger difference at low certainty, and the 2023 Iranian trial of 60 people found none. Every sham-controlled trial on this page enrolled fewer than 200 people, and ACUDIN, with 180, used a placebo laser rather than a sham needle. Nerve conduction results also diverge: ACUDIN found improvement against placebo, ACUDPN found no meaningful change against a waiting list, and the larger meta-analyses draw their conduction results mostly from trials against drugs with unblinded patients. A [three-armed trial](https://doi.org/10.1136/bmjopen-2023-079354) registered by the Beijing University of Chinese Medicine plans to compare 24 sessions of electroacupuncture with sham acupuncture and usual care in 240 people at four hospitals in China; a search of Europe PMC in October 2026 found only its 2024 protocol. Trials in nerve damage from cancer drugs are covered in [Chemotherapy-induced neuropathy](/wiki/evidence/chemotherapy-induced-neuropathy).

AcuiQ’s [diabetic peripheral neuropathy](/symptoms/neuropathy-peripheral-diabetic) and [peripheral diabetic neuropathy](/symptoms/neuropathy-diabetic-peripheral) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Ju ZY, Wang K, Cui HS, et al., Acupuncture for neuropathic pain in adults, Cochrane Database of Systematic Reviews 2017 — https://doi.org/10.1002/14651858.cd012057.pub2
2. Liu J, Lin Y, Huang Y, et al., Efficacy and safety of acupuncture for painful diabetic neuropathy: a systematic review and meta-analysis, Frontiers in Neurology 2024 — https://doi.org/10.3389/fneur.2024.1402458
3. Lan L, Wang L, Sadeghirad B, et al., Acupuncture for the management of chronic diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials, Current Pain and Headache Reports 2025 — https://doi.org/10.1007/s11916-025-01386-z
4. Lin S, Qin Y, Li M, et al., Acupuncture for diabetic peripheral neuropathy: a systematic review and Bayesian network meta-analysis, Medicine 2025 — https://doi.org/10.1097/md.0000000000043796
5. Jiang J, Shen H, Zhang Y, et al., Acupuncture treatment of diabetic peripheral neuropathy: an overview of systematic reviews based on evidence mapping, Frontiers in Neurology 2024 — https://doi.org/10.3389/fneur.2024.1420510
6. Garrow AP, Xing M, Vere J, Verrall B, Wang L, Jude EB, Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT, Acupuncture in Medicine 2014 — https://doi.org/10.1136/acupmed-2013-010495
7. Meyer-Hamme G, Friedemann T, Greten J, Gerloff C, Schroeder S, Electrophysiologically verified effects of acupuncture on diabetic peripheral neuropathy in type 2 diabetes: the randomized, partially double-blinded, controlled ACUDIN trial, Journal of Diabetes 2021 — https://doi.org/10.1111/1753-0407.13130
8. Zardosht R, Arabi A, Akhlaghi M, et al., Evaluating the effect of acupuncture on symptoms of diabetic peripheral neuropathy (DPN) among individuals with diabetic neuropathy: a single-blind, randomized trial study, Journal of Diabetes and Metabolic Disorders 2023 — https://doi.org/10.1007/s40200-023-01314-1
9. Pérez Hernández MF, Rodríguez Guerrero E, Ocharan Hernández ME, et al., Effect of electroacupuncture for pain relief in diabetic distal symmetric polyneuropathy: a pilot randomized clinical trial, BMC Complementary Medicine and Therapies 2025 — https://doi.org/10.1186/s12906-025-05135-y
10. Chao MT, Schillinger D, Nguyen U, et al., A randomized clinical trial of group acupuncture for painful diabetic neuropathy among diverse safety net patients, Pain Medicine 2019 — https://doi.org/10.1093/pm/pnz117
11. Dietzel J, Habermann IV, Hörder S, et al., Acupuncture in patients with diabetic peripheral neuropathy-related complaints: a randomized controlled clinical trial, Journal of Clinical Medicine 2023 — https://doi.org/10.3390/jcm12062103
12. Hoerder S, Habermann IV, Hahn K, et al., Acupuncture in diabetic peripheral neuropathy: neurological outcomes of the randomized acupuncture in diabetic peripheral neuropathy trial, World Journal of Diabetes 2023 — https://doi.org/10.4239/wjd.v14.i12.1813
13. American Diabetes Association Professional Practice Committee, 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes–2026, Diabetes Care 2026 — https://doi.org/10.2337/dc26-S012
14. Price R, Smith D, Franklin G, et al., Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary, Neurology 2022 — https://doi.org/10.1212/WNL.0000000000013038
15. American Academy of Neurology, Oral and topical treatment of painful diabetic polyneuropathy practice guideline update: guideline detail (reaffirmed 8 February 2025) — https://www.aan.com/Guidelines/home/GuidelineDetail/1055
16. NICE, Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173), 2013, updated 2020 — https://www.nice.org.uk/guidance/cg173/chapter/Recommendations
17. NICE, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193), 2021 — https://www.nice.org.uk/guidance/ng193/chapter/Recommendations
18. Zhuang R, Xiong Z, Yan S, et al., Efficacy of electro-acupuncture versus sham acupuncture for diabetic peripheral neuropathy: study protocol for a three-armed randomised controlled trial, BMJ Open 2024 — https://doi.org/10.1136/bmjopen-2023-079354