Effects of Methylcobalamin on Diabetic Peripheral Neuropathy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIA Haiyan ¹ , TIAN Haoming ¹ , WEI Dong ²

1. Division of Endocrinology; Department of Internal Medicine; West China Hospital; Sichuan University; Chengdu 610041; China2. Division of Endocrinology; The Second People s Hospital of Chengdu; Chengdu 610017;

Corresponding?author：

Keywords：

Methylcobalamin; Diabetic peripheral neuropathy; Randomized controlled trials; Quasi-randomized controlled trials; Systematic review

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Objective 　To review systematically whether there is enough existing evidence that methylcobalamin is effective and safe in the treatment of the patients with diabetic peripheral neuropathy.
Methods 　A Cochrane systematic review of all relevant randomized or quasi-randomized controlled trials of methycobalamin for diabetic peripheral neuropathy was performed. Clinical trials were searched from Cochrane Controlled Trials Register (Issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1980 to January 2004), the Chinese Biological Medicine Database (1978 to January 2004), the Chinese Science and Technology Journal Full-text Database (1989 to January 2004) and references of all included trials. The selection of studies, data extraction and assessment of methodological quality were performed independently by two reviewers. The following outcomes were assessed: effectiveness of clinical signs and symptoms, sensory nerve and motor nerve conduction velocities and serious adverse events of methylcobalamin.
Results 　Thirty randomized clinical trials including 1 949 patients met the inclusion criteria. The quality of the most included trials was of low level. The "funnel plot" of the comparison of thirteen studies of methylcobalamin with other B Vitamins studies showed symmetry, which indicated less possible publication bias and the result was partly reliable, but it could not indicate the whole publication biases. The results of meta-analysis indicated that methylcobalamin showed significantly positive effects on the improvement of the signs and symptoms of peripheral neuropathy, and the effects were better than the other vitamin B agents. The increase of some nerves conduction velocities by methylcobalamin was better than by the other vitamin B. No serious adverse events were observed during the treatment period.
Conclusions 　Methylcobalamin appears to be a safe and effective treatment on diabetic peripheral neuropathy. However, the evidence is not b because of the low quality of most trials. Rigorously designed, randomized, double-blinded, placebo-controlled trials of methylcobalamin for diabetic peripheral neuropathy are needed to further assess the effect.

Citation： JIA Haiyan,TIAN Haoming,WEI Dong. Effects of Methylcobalamin on Diabetic Peripheral Neuropathy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(8): 609-618. doi: Copy

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1. 汪仁斌, 劉興洲. 糖尿病神經病的發病機制[J]. 中日友好醫院學報, 1998; 12(1): 87.
2. 于鳳玲, 徐方江, 于鳳泉, 王艷芝. 甲鈷胺治療糖尿病周圍神經病變30例[J]. 醫藥導報, 2001; 20(9): 577.
3. 龐明. 彌可保對糖尿病周圍神經病變療效觀察[J]. 海峽藥學, 1997; 9(3): 32.
4. 龐建華, 康勝群, 王燕. 彌可保治療糖尿病周圍神經病變臨床觀察[J]. 河北醫學, 1998; 4(1): 87.
5. 姜雅秋, 劉國良, 王秋月, 王玉珍. 彌可保治療糖尿病周圍神經病變的療效觀察[J]. 遼寧醫學雜志, 1998; 12(2): 100～101.
6. 孟麗琴. 彌可保對糖尿病周圍神經病變的療效. 鎮江醫學院學報, 1999; 9(1): 97～98.
7. 馬書平, 趙志剛, 劉衛紅, 文世林, 魯平. 甲鈷胺對糖尿病周圍神經病變體感誘發電位潛時的影響[J]. 中國實用內科雜志, 1999; 19(7): 425～426.
8. 杜慶萍, 張福華, 王旭光, 趙頡. 彌可保治療糖尿病周圍神經病變臨床觀[J]. 青海醫藥雜志, 1999; 29(3): 23～24.
9. 康勝群, 支忠繼. 彌可保治療糖尿病周圍神經病變療效觀察[J]. 現代中西醫結合雜志, 1999; 8(12): 2067.
10. 甘華俠, 昌玉蘭, 陳惠賢, 李雯霞. 彌可保治療糖尿病周圍神經病變的療效觀察. 江西醫學院學報, 2000; 40(4): 102, 104.
11. 楊榮禮, 李勵, 呂麗麗, 項潔, 趙向東. 甲鈷胺治療老年糖尿病周圍神經病變的臨床觀察[J]. 徐州醫學院學報, 2000; 20(6): 468～469.
12. 施克新. 彌可保治療糖尿病周圍神經病變63例. 錦州醫學院學報, 2000;21(1):39～40.
13. 李雪鋒, 胡清, 朱大菊. 甲鈷胺治療糖尿病周圍神經病變的臨床評價[J]. 中國基層醫藥, 2001; 8(5): 452～453.
14. 徐靜, 孫艷波. 彌可保治療糖尿病周圍神經病56例療效觀察[J]. 中國臨床康復, 2002; 6(7): 1031.
15. 司獻軍. 甲鈷胺治療糖尿病周圍神經病變28例觀察[J]. 河南實用神經疾病雜志, 2002; 5(3): 55～56.
16. 張蜀平, 陸菊明, 潘長玉. 彌可保治療糖尿病周圍神經病變療效觀察[J]. 天津醫藥, 1997; 25(6): 337～340.
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18. 李光偉, 北京彌可保臨床觀察協作組. 甲鈷胺治療糖尿病神經病變的臨床觀察[J]. 中華內科雜志, 1999; 38(1): 14～17.
19. 馮來會, 馮元森, 李彩霞, 楊洪文, 史廣巍. 甲鈷胺與前列腺素E1聯合應用治療周圍神經病變療效觀察[J]. 河南實用神經疾病雜志, 1999; 2(4): 25.
20. 岑海燕, 施文瑜. 彌可保治療糖尿病周圍神經病變療效觀察[J]. 南通醫學院學報, 2000; 20(4): 396～397.
21. 沈云峰, 鄒文華, 賴曉陽. 彌可保聯用前列腺素E1治療糖尿病神經病變的療效觀察[J]. 江西醫學院學報, 2001; 41(5): 113～114.
22. 朱旭萍, 周智廣. PGE1加甲鈷胺治療糖尿病周圍神經病變[J]. 湖南醫科大學學報, 2001; 26(4): 343～344.
23. 徐錫祥, 顧峰. 彌可保治療糖尿病多發性末梢神經病變[J]. 中國臨床醫學, 2003; 10(1): 64～65.
24. 張秀菊, 張秀芬. 彌可保治療糖尿病周圍神經病變51例療效觀察[J]. 中國臨床醫藥研究雜志, 2002; (68): 5655.
25. 鐘樹妹, 劉澤洪, 王健雄, 李韶今. 彌可保聯用血栓通治療糖尿病周圍神經病變短期療效[J]. 中國臨床康復, 2002; 6(23): 3582.
26. 張蜀平, 陸菊明, 潘長玉, 尹嶺, 竇京濤. 彌可保對糖尿病周圍神經病變治療作用的實驗研究[J]. 中華內分泌代謝雜志, 1998; 14(2): 130～132.
27. Greene DA, Sima AAF, Stevens MJ, Feldman EL, Lattimer SA. Complication: neuropathy, pathogenetic consideration[J]. Diabetes Care, 1992; 15 (12): 1902-1925.
28. Wang RB, Liu XZ. Pathogenesis of diabetic neuropathy[J]. Journal of China-Japan Friendship Hospital, 1998; 12 (1): 87.
29. Devathasan G, Teo WL, Mylvaganam A, Thai AC, Chin JH. Methylcobalamin in chronic diabetic neuropathy. A double-blind clinical and electrophysiological study[J]. Clin Trials J, 1986; 23(2): 130-140.
30. Yaqub BA, Siddique A, Sulimani R. Effects of methylcobalamin on diabetic neuropathy[J]. Clin Neurol Neurosurg, 1992; 94(2): 105-111.
31. Yu FL, Xu FJ, Yu FQ, Wang YZ. Effects of methylcobalamin on diabetic peripheral neuropathy: analysis of 32 cases[J]. Herald of Medicine, 2001; 20(9): 577.
32. Pang M. Effects of methylcobalamin on diabetic peripheral neuropathy[J]. Strait Medicine, 1997; 9(3): 32.
33. Pang JH, Kang SQ, Wang Y. Clinical observation of effects of methylcobalamin on diabetic peripheral neuropathy[J]. Hebei Medicine, 1998; 4(1): 87.
34. Wu DH, Zhao HY, Liu YH, Shi XQ. Clinical observation of effects of methylcobalamin on diabetic peripheral neuropathy[J]. Harbing Medical Journal, 1998; 18(3): 13-14.吳東紅, 趙環宇, 劉岳鴻, 史秀琴. 彌可保治療糖尿病周圍神經病變的臨床觀察[J]. 哈爾濱醫藥, 1998; 18(3): 13～14.
35. Jiang YQ, Liu GL, Wang QY, Wang YZ. Effects of methylcobalamin on diabetic peripheral neuropathy[J]. Liaoning Medical Journal, 1998; 12(2): 100-101.
36. Meng LQ. Effects of methylcobalamin on diabetic peripheral neuropathy[J]. Journal of ZhenJiang Medical College, 1999; 9(1): 97-98.
37. Ma SP, Zhao ZG, Liu WH, Wen SL, Lu P. Effects of mecobalamin on latent period of somatosensory evked potential of diabetic peripheral neuropathy[J]. Chinese Journal of practical internal medicine, 1999; 19(7): 425-426.
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Chinese Journal of Evidence-Based Medicine

Effects of Methylcobalamin on Diabetic Peripheral Neuropathy: A Systematic Review

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