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, 刘兴洲. 糖尿病神经病的发病机制[J]. 中日友好医院学报, 1998; 12(1): 87.
2. 于凤玲, 徐方江, 于凤泉, 王艳芝. 甲钴胺治疗糖尿病周围神经病变30例[J]. 医药导报, 2001; 20(9): 577.
3. 庞明. 弥可保对糖尿病周围神经病变疗效观察[J]. 海峡药学, 1997; 9(3): 32.
4. 庞建华, 康胜群, 王燕. 弥可保治疗糖尿病周围神经病变临床观察[J]. 河北医学, 1998; 4(1): 87.
5. 姜雅秋, 刘国良, 王秋月, 王玉珍. 弥可保治疗糖尿病周围神经病变的疗效观察[J]. 辽宁医学杂志, 1998; 12(2): 100～101.
6. 孟丽琴. 弥可保对糖尿病周围神经病变的疗效. 镇江医学院学报, 1999; 9(1): 97～98.
7. 马书平, 赵志刚, 刘卫红, 文世林, 鲁平. 甲钴胺对糖尿病周围神经病变体感诱发电位潜时的影响[J]. 中国实用内科杂志, 1999; 19(7): 425～426.
8. 杜庆萍, 张福华, 王旭光, 赵颉. 弥可保治疗糖尿病周围神经病变临床观[J]. 青海医药杂志, 1999; 29(3): 23～24.
9. 康胜群, 支忠继. 弥可保治疗糖尿病周围神经病变疗效观察[J]. 现代中西医结合杂志, 1999; 8(12): 2067.
10. 甘华侠, 昌玉兰, 陈惠贤, 李雯霞. 弥可保治疗糖尿病周围神经病变的疗效观察. 江西医学院学报, 2000; 40(4): 102, 104.
11. 杨荣礼, 李励, 吕丽丽, 项洁, 赵向东. 甲钴胺治疗老年糖尿病周围神经病变的临床观察[J]. 徐州医学院学报, 2000; 20(6): 468～469.
12. 施克新. 弥可保治疗糖尿病周围神经病变63例. 锦州医学院学报, 2000;21(1):39～40.
13. 李雪锋, 胡清, 朱大菊. 甲钴胺治疗糖尿病周围神经病变的临床评价[J]. 中国基层医药, 2001; 8(5): 452～453.
14. 徐静, 孙艳波. 弥可保治疗糖尿病周围神经病56例疗效观察[J]. 中国临床康复, 2002; 6(7): 1031.
15. 司献军. 甲钴胺治疗糖尿病周围神经病变28例观察[J]. 河南实用神经疾病杂志, 2002; 5(3): 55～56.
16. 张蜀平, 陆菊明, 潘长玉. 弥可保治疗糖尿病周围神经病变疗效观察[J]. 天津医药, 1997; 25(6): 337～340.
17. 徐震. 弥可保治疗糖尿病神经病变11例疗效观察[J]. 嘉兴医学, 2000; 16(2): 121～122.
18. 李光伟, 北京弥可保临床观察协作组. 甲钴胺治疗糖尿病神经病变的临床观察[J]. 中华内科杂志, 1999; 38(1): 14～17.
19. 冯来会, 冯元森, 李彩霞, 杨洪文, 史广巍. 甲钴胺与前列腺素E1联合应用治疗周围神经病变疗效观察[J]. 河南实用神经疾病杂志, 1999; 2(4): 25.
20. 岑海燕, 施文瑜. 弥可保治疗糖尿病周围神经病变疗效观察[J]. 南通医学院学报, 2000; 20(4): 396～397.
21. 沈云峰, 邹文华, 赖晓阳. 弥可保联用前列腺素E1治疗糖尿病神经病变的疗效观察[J]. 江西医学院学报, 2001; 41(5): 113～114.
22. 朱旭萍, 周智广. PGE1加甲钴胺治疗糖尿病周围神经病变[J]. 湖南医科大学学报, 2001; 26(4): 343～344.
23. 徐锡祥, 顾峰. 弥可保治疗糖尿病多发性末梢神经病变[J]. 中国临床医学, 2003; 10(1): 64～65.
24. 张秀菊, 张秀芬. 弥可保治疗糖尿病周围神经病变51例疗效观察[J]. 中国临床医药研究杂志, 2002; (68): 5655.
25. 钟树妹, 刘泽洪, 王健雄, 李韶今. 弥可保联用血栓通治疗糖尿病周围神经病变短期疗效[J]. 中国临床康复, 2002; 6(23): 3582.
26. 张蜀平, 陆菊明, 潘长玉, 尹岭, 窦京涛. 弥可保对糖尿病周围神经病变治疗作用的实验研究[J]. 中华内分泌代谢杂志, 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.吴东红, 赵环宇, 刘岳鸿, 史秀琴. 弥可保治疗糖尿病周围神经病变的临床观察[J]. 哈尔滨医药, 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.
38. Du QP, Zhang FH, Wang XG, Zhao J. Clinical observation of effects of methylcobalamin on diabetic peripheral neuropathy[J]. Qinghai Medical Journal, 1999; 29(3): 23-24.
39. Kang SQ, Zhi ZJ. Clinical observation of effects of methylcobalamin on diabetic peripheral neuropathy[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 1999; 8(12): 2067.
40. Gan HX, Chang YL, Chen HX, Li WX. Clinical observation of effects of methylcobalamin on diabetic peripheral neuropathy[J]. Acta Academiae Medicinae Jiangxi, 2000; 40(4): 102, 104.
41. Yang RL, Li L, Lv LL, Xiangjie, Zhaoxiangdong. Clinical observation of effects of mecobalamin on older diabetic patients with peripheral neuropathy[J]. Acta Academiae Medicinae Xuzhou, 2000; 20(6): 468-469.
42. Shi KX. Effects of methylcobalamin on diabetic peripheral neuropathy: analysis of 63 cases[J]. Acta Academiae Medicinae Jinzhou, 2000; 21(1): 39-40.
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Chinese Journal of Evidence-Based Medicine

Effects of Methylcobalamin on Diabetic Peripheral Neuropathy: A Systematic Review

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