Mudan Granules for Diabetic Peripheral Neuropathy: A Systematic Review of Preclinical and Clinical Evidence
Bibliographic record
Abstract
Abstract Background Mudan granules has been used in China to treat diabetic peripheral neuropathy (DPN), but there is a lack of systematic review of reports in this area. The aim of this systematic review was to evaluate the efficacy and safety of Mudan granules in the treatment of diabetic peripheral neuropathy. Methods Initial studies were searched from PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), VIP database, Wanfang electronic databases. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The meta-analysis was performed by Stata 16.0 software. For dichotomous and continuous outcomes, the relative risk (RR) and standardized mean difference (SMD) with 95% confidence interval (CI) were conducted, respectively. Results 51 randomized controlled trials (RCTs) involving 5,416 patients were included. In the meta-analysis, compared with routine treatment (RT) alone, Mudan granules plus RT reduced Toronto clinical scoring system (TCSS) score (SMD, -0.52; 95% CI, -0.66 to -0.38; P < 0.01), total symptoms score (TSS) (SMD, -1.44; 95% CI, -2.88 to -0.00; P = 0.05), serum homocysteine (Hcy) levels (SMD, -3.84; 95% CI, -5.99 to -1.70; P < 0.01), serum high sensitive C-reactive protein (hs-CRP) levels (SMD, -1.68; 95% CI, -3.29 to -0.08; P = 0.04), and improved total clinical efficacy (RR, 1.23; 95% CI, 1.19 to 1.27; P < 0.01) and serum superoxide dismutase (SOD) levels (SMD, 1.54; 95% CI, 1.13 to 1.95; P < 0.01). Besides, Mudan granules presented an adjuvant efficacy on median motor nerve conduction velocity (SMD, 1.61; 95% CI, 1.16 to 2.07), median sensory nerve conduction velocity (SMD, 1.73; 95% CI, 1.26 to 2.20), common peroneal motor nerve conduction velocity (SMD, 1.48; 95% CI, 1.10 to 1.86), common peroneal sensory nerve conduction velocity ( SMD, 1.57; 95% CI, 1.23 to 1.92), tibial motor nerve conduction velocity (SMD, 1.34; 95% CI, 0.82 to 1.87), and tibial sensory nerve conduction velocity (SMD, 1.03; 95% CI, 0.86 to 1.20). In terms of adverse events, there was no statistically significant difference between the trial group and the control group (P=0.87). Five preclinical studies were also retrieved for the study. Animal studies have shown that Mudan granules have anti-oxidative stress effects and could reduce the inflammatory response. It may improve peripheral nerve injury in diabetic rats by modulating the TLR4/MyD88/NF-κB pathway, TLR4/p38 MAPK pathway and PI3K/AKT pathway. Conclusions Mudan granules presented an adjuvant efficacy on patients with DPN and could improve the oxidative stress and inflammatory levels in preclinical models. However, high-quality original studies are needed to further prove the evidence. Systematic review registration: PEROPERO (CRD42022373113)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.011 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".