Clinical study on the application of acupoint injection therapy with vitamin B1 in patients with diabetic peripheral neuropathy

Ran-Hui Kang; O Kwang-Chun

doi:10.4103/jdep.jdep_9_18

ORIGINAL ARTICLE

Year : 2019 | Volume : 2 | Issue : 1 | Page : 4-7

Clinical study on the application of acupoint injection therapy with vitamin B1 in patients with diabetic peripheral neuropathy

Ran-Hui Kang, O Kwang-Chun
Department of Endocrinology and Metaboism, Pyongyang Medical College, Kim II Sung University, Pyongyang, DPR Korea

Date of Submission	24-Jul-2018
Date of Decision	04-Nov-2018
Date of Acceptance	08-Feb-2019
Date of Web Publication	11-Apr-2020

Correspondence Address:
Dr. Ran-Hui Kang
Ryonhwa-Dong, Central District, Pyongyang
DPR Korea

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdep.jdep_9_18

Abstract

Context: Acupoint injection therapy with Vitamin B₁is very effective in the management of diabetic peripheral neuropathy (DPN), and there are few adverse side effects. Aims: The overall purposes of our study are to determine the specific methods of acupoint injection therapy with Vitamin B₁for patients with DPN and to demonstrate the effectiveness of this therapy for DPN patients. Settings and Design: The enrolled patients were divided into two groups – the experimental group (75 patients) and the control group (51 patients). Subjects and Methods: We used four main acupoints in our study – EX-B3, ST36, GB39, and GB34. We compared the changes of DPN symptoms, days of pain loss, changes of tendon reflexes, and electromyographic (EMG) parameters between two groups after 15 days of treatment. Statistical Analysis Used: T-test was used to compare the characteristics between different treatments. Results: The best acupoint set for performing the acupoint injection therapy with 5% Vitamin B₁, includes EX-B3, ST36, GB34, and GB39. The mean efficiency rate in terms of changes of DPN symptoms was 84.5% that is significantly lower compared with 61.9% of control group. Furthermore, the day of the pain loss of experimental group was significant lower than that of control group and the efficiency rates in terms of patellar reflex and Achilles tendon reflex were 90.0% and 89.1%, respectively (P < 0.05). In the experimental group, EMG parameters were improved significantly. Conclusions: Our study suggests that the acupoint injection therapy with Vitamin B₁is preferable, easier, and cost-effective approach in terms of DPN treatment.

Keywords: Acupoints, diabetic peripheral neuropathy, Vitamin B1

How to cite this article:
Kang RH, Kwang-Chun O. Clinical study on the application of acupoint injection therapy with vitamin B1 in patients with diabetic peripheral neuropathy. J Diabetes Endocr Pract 2019;2:4-7

How to cite this URL:
Kang RH, Kwang-Chun O. Clinical study on the application of acupoint injection therapy with vitamin B1 in patients with diabetic peripheral neuropathy. J Diabetes Endocr Pract [serial online] 2019 [cited 2023 Dec 1];2:4-7. Available from: https://www.jdeponline.com/text.asp?2019/2/1/4/282232

Introduction

In case of diabetic peripheral neuropathy (DPN), the management of pain is essential to help prevent further neurological damage and progression.^{[1],[2],[3],[4],[5],[6]}

Many guidelines recommend the use of some drugs, but they are often expensive and result in a number of adverse effects.^{[7],[8],[9],[10],[11],[12]}

The acupoint injection therapy with Vitamin B₁ is the preferred treatment option for patients with DPN these days, but its specific methods and effects on DPN have not been sufficiently investigated.^[13]

Therefore, the purposes of our study are to determine the specific methods of this therapy and to demonstrate the effectiveness for DPN patients.

Subjects and Methods

Individuals with DPN (n = 126, 84 males, mean age: 54.3 ± 4.1) were recruited at the Hospital of the Pyongyang Medical College, Kim II Sung University. This study was approved by the local ethical committee of our hospital. DPN was determined as previously.

The therapeutic modality of the acupoint injection therapy with Vitamin B1 contains two sides – acupoint stimulation using a needle of 5-g syringe^[14],[15] and administration of Vitamin B1 on the corresponding acupoint.^[13],[16]

We used four main acupoints in our study: EX-B3, ST36, GB39, and GB34.^[14],[15] To determine the exact acupoints for injection with Vitamin B₁, 45 patients with DPN were divided into three groups according to acupoint prescriptions. In this case, days of pain loss (DPL) were evaluated every 5 days in three groups.

To demonstrate the effectiveness of acupoint injection therapy with Vitamin B₁, the enrolled patients were divided into two groups – the experimental group (75 patients treated with acupoint injection therapy with Vitamin B1) and the control group (51 patients treated with only acupoint stimulation using needles). We performed acupoint injection therapy with Vitamin B₁(0.5 mL of 5% Vitamin B₁ was injected in each acupoint using a 5-g syringe) at four main acupoints in the DPN patients of experimental group, and only performed acupoint stimulation for 20 min using needles in the DPN patients of control group.^{[14],[15],[16]}

In that case, the depth of the acupoint injection was 1–1.5 chi. “chi” is a traditional unit of length in the field of acupoint science. Its correct length depends on the corresponding patient and is usually about 2–2.5 cm.^[14]

Moreover, the angle of the acupoint injection was usually 60°–90° in cases of EX-B3, ST36, and GB34. In case of GB39, the angle was 30°.^[14]

We compared the changes of DPN symptoms, DPL, changes of tendon reflexes, and electromyographic (EMG) parameters between two groups after 15 days of treatment by means of t-test to evaluate the effectiveness of new acupoint injection therapy with Vitamin B₁.

The results are expressed as mean values ± standard deviation, and t-test was used to compare the characteristics between different treatments.

Results

Determination of acupoints for acupoint injection therapy with Vitamin B₁

As shown in [Table 1], the best acupoint set for performing the acupoint injection therapy with 5% Vitamin B₁, includes EX-B3, ST36, GB34, and GB39. It also shows the reasonable period of this therapy can be 10 days. Statistical comparison of three subgroups with the use of Vitamin B₁ revealed that acupoints are more important in terms of DPN treatment in one sense.

Table 1: Evaluation of days of pain loss after the acupoint injection therapy with Vitamin B¹

Click here to view

Evaluation of effectiveness of acupoint injection therapy with Vitamin B₁

As shown in [Table 2], the mean efficiency of the acupoint injection with Vitamin B₁ in terms of changes of DPN symptoms was 84.5% that is significantly higher compared with 61.9% of control group.

Table 2: Changes of diabetic peripheral neuropathy symptoms

Click here to view

[Table 3] and [Figure 1] indicate that the DPL of experimental group was significantly lower than that of control group.

Table 3: Changes of the days of pain loss

Click here to view

Figure 1: Days of pain loss among the patients with diabetic peripheral neuropathy after the acupoint injection therapy with Vitamin B₁

Click here to view

As shown in [Table 4] and [Table 5], the efficiency rates in terms of patellar reflex and Achilles tendon reflex were 90.9% and 89.1%, respectively. They are significantly higher than those of control group (P < 0.05).

Table 4: Changes of the patellar reflex

Click here to view

Table 5: Changes of the Achilles tendon reflex

Click here to view

In the experimental group, the motor nerve conduction velocities (MCVs) of the tibial nerve were increased significantly, and the H-wave intervals were decreased significantly [Table 6].

Table 6: Changes of EMG parameters

Click here to view

Discussion

Recent studies and several guidelines indicated that DPN is not a simple neuropathy but also a serious condition that can cause diabetic foot ulcers and many other complications. They also pointed out that blood glucose must be brought to normal levels to help prevent further neurological damage and progression of neuropathy, and the pain must be treated by some medications including pregabalin or duloxetine.^[7],[10] However, these medications have many serious side effects. Beside the management of blood glucose and the neuropathic pain, there are few treatment approaches to improve the DPN significantly.^{[8],[11],[12]}

The results of our study indicate that EX-B3, ST36, GB34, and GB39 acupoints were the best ones to be injected with 5% Vitamin B₁ and when it comes to the treatment period, 10 days intervals seems an optimal time for repeated injections.

The overall efficiency rate in terms of improvement of DPN symptoms including numbness, weakness, convulsions, and night pain was 84.5%, the mean day of the pain loss was 4.4, the efficiency rate in case of patellar reflex was 90.0%, and the efficiency rate in case of Achilles tendon reflex was 89.1%. These parameters were significantly different from those of control group significantly.

Our results indicate that acupoint injection therapy with Vitamin B₁ can improve not only the DPN symptoms and syndromes but also abnormal neurological findings including abnormal reflexes.

In addition, therapy can improve the EMG parameters including the MCVs and H-wave intervals in the tibial nerve significantly. It may be due to the neurotrophic action, cholinesterase-inhibiting action, and local stimulating action of Vitamin B₁. These results provide a basis for the application of acupoint injection therapy with Vitamin B₁ on the DPN patients.^[2],[7],[13]

Based on our findings, we “belive this modality of treatment should be utlized more in the management of painful diabetic neuropathy.

Conclusion

Our study suggests that the acupoint injection therapy with vitamin B1 is effective, easy and cost-effective approach for management of DPN as it can shorten the treatment period and improve the DPN symptoms and syndromes, affected exam parameters significantly to improve the quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Boulton AJ, Malik RA, Arezzo JC, Sosenko JM. Diabetic somatic neuropathies. Diabetes Care 2004;27:1458-86.
2.	Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: A statement by the American Diabetes Association. Diabetes Care 2005;28:956-62.
3.	Bennett M. The LANSS pain scale: The Leeds assessment of neuropathic symptoms and signs. Pain 2001;92:147-57.
4.	Backonja MM, Krause SJ. Neuropathic pain questionnaire – Short form. Clin J Pain 2003;19:315-6.
5.	Boulton A. Management of diabetic peripheral neuropathy. Clin Diabetes 2005;23:9-15.
6.	Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010;82:151-8.
7.	William T, George B, Lawrence B, Andrew B, David D, Mary DG, et al. Microvascular complications and foot care. Diabetes Care 2017;40 Suppl 1:S88-98.
8.	Waldschmitt C, Vogel F, Pfuhlmann B, Hiemke C. Duloxetine serum concentrations and clinical effects. Data from a therapeutic drug monitoring (TDM) survey. Pharmacopsychiatry 2009;42:189-93.
9.	Boulton AJ. Is duloxetine more effective than amitriptyline for painful diabetic neuropathy? Curr Diab Rep 2011;11:230.
10.	Smith HS, Argoff CE. Pharmacological treatment of diabetic neuropathic pain. Drugs 2011;71:557-89.
11.	Finnerup NB, Jensen TS. Clinical use of pregabalin in the management of central neuropathic pain. Neuropsychiatr Dis Treat 2007;3:885-91.
12.	Boyle J, Eriksson ME, Gribble L, Gouni R, Johnsen S, Coppini DV, et al. Randomized, placebo-controlled comparison of amitriptyline, duloxetine, and pregabalin in patients with chronic diabetic peripheral neuropathic pain: Impact on pain, polysomnographic sleep, daytime functioning, and quality of life. Diabetes Care 2012;35:2451-8.
13.	Gubler CJ. Thiamin. In: Machlin LJ, editors. Handbook of Vitamins: Nutritional, Biochemical, and Clinical Aspects. New York, USA: Marcel Dekker; 1984. p. 245.
14.	Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: A long-term study. Diabetes Res Clin Pract 1998;39:115-21.
15.	Guo CE. Peripheral diabetic neuropathy treated by integrative medicine. J Sichuan Tradit Chin Med 2001;19:39.
16.	Xin L, Tong WX, Zhang RF. Auxiliary therapy of Xuesaitong injection for DPN: A report of 31 patients. Chin J Integr Tradit West Med 2003;23:230.