Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guide...Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guidelines. Objective: To determine the clinical and neurophysiological effects of 1500 μgm/day of oral methylcobalamin among subjects with diabetic polyneuropathy. Methodology: We conducted a prospective, open-label study on adult diabetic subjects with polyneuropathy who were given 1500 μgm/day of oral methylcobalamin over 24-weeks. The primary outcome measure was the Toronto Clinical Scoring System (CSS) and secondary measures were Subjective Impression of Change, Clinicians Impression of Change and neurophysiological parameters. Results: Out of forty eight subjects, thirty seven completed treatment and twenty one agreed to have repeat neurophysiologic study post-treatment. At the end of treatment, there was a significant decline in the Toronto CSS score (p < 0.0001) indicating improvement. This was observed across all stages of severity and in any duration of diabetes whether more or less than 10 years. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling (p < 0.03), upper limb symptoms (p < 0.003), ataxia (p < 0.004), and signs of impaired position (P < 0.009) sense, vibration sense (p < 0.0001), pinprick sensation (p < 0.004) and knee reflex (p < 0.004). No significant improvement was seen in the secondary outcomes (both p=0.06) except for ulnar nerve amplitude and distal latency. Conclusion: This 24-week open label study demonstrated that symptoms of diabetic polyneuropathy significantly improved among subjects given methylcobalamin 1500 μgm/day and new symptoms did not emerge over the 24 week observation period. Larger controlled trials are needed to corroborate these findings.展开更多
Background: The distal sensory polyneuropathy (DSP) was more frequent among diabetics, although its determinant was not well known among diabetics in Benin. Objective: We aimed to assess the frequency of DSP and its d...Background: The distal sensory polyneuropathy (DSP) was more frequent among diabetics, although its determinant was not well known among diabetics in Benin. Objective: We aimed to assess the frequency of DSP and its determinants among diabetics at Parakou. Methods: It was a cross-sectional study carried out from 1 March to 31 August 2012 and included 336 diabetics followed at the diabetes unit of Parakou hospital. The diagnosis of DSP was based on DNS (Diabetic Neuropathy Score) criteria and other criteria. All data concerning the diabetes mellitus were recorded. We used Epi-Info and SPSS 16.0 software to perform analysis. Results: They were 187 females (56.0%) with the mean age of 54.9 ± 10.9 years. 298 patients fulfilled criteria for DSP;the overall prevalence of DSP was 88.7%. The main associated factors in multivariate analysis were treatment duration of diabetes more than 4 years: OR = 36.7 [4.0 - 336.9];the elevated glycaemia: OR = 3.1 [1.4 - 7.1];the activity with high income: OR = 0.2 [0.0 - 0.8];the ethnicity: nagots/fon: OR: 3.7 [1.4 - 12.5]. Conclusion: Those results suggested the high frequency of DSP among diabetics at Parakou.展开更多
BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined w...BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined with a health-promoting program,can improve the signs and symptoms of diabetic polyneuropathy,enhance gait,res-tore mobility in the foot and ankle joints,redistribute pressure while walking,and increase foot strength and function.As a result,these exercise programs can help mitigate the risk factors for diabetic foot ulceration.AIM To determine the effect of supervised stretching,strengthening,functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.METHODS This was a randomized controlled trial conducted in a tertiary hospital.The study included 82 participants allocated into the intervention group(alpha-lipoic acid and exercise on 15 consecutive therapeutic days,n=42)and control group(alpha lipoic acid only,n=40).Muscle strength included dorsal and plantar flexors dynamometry and strength score,while range of motion included ankle,subtalar and first metatarsophalangeal joint goniometry.RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15(9.9±7.2 vs 0.1±3.3;P=0.006)and month 6(2.8±7.3 vs-0.9±4.1;P<0.001),subtalar joint on day 15(7.5±5.1 vs-0.25±2.25;P<0.001)and month 6(3.9±6.4 vs-0.13±3.49;P<0.001).Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15(2.62±1.69 vs 0.10±1.35;P<0.001)and month 6(0.66±2.38 vs-0.75±1.94;P=0.004)as well as plantar flexors on day 15(3.3±1.6 vs 0.3±1.5;P<0.001)and month 6(1.8±2.2 vs-0.9±2.1;P<0.001).Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15(-1.45±1.42 vs-0.03±0.16;P<0.001)and month 6(-1.17±1.53 vs 0.20±0.56;P<0.001).CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility,as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.展开更多
Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patie...Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patients were randomized into western medication group,acupuncture group,and combination group,with 31 cases in each.The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets.The patients in acupuncture group were treated with acupuncture,and the acupoints were selected according to the symptoms.The needles were retained for 30 min,once a day.The patients in combination group were treated with both western medication and acupuncture,specific methods as the above.The treatments were for 18 days in succession in all of three group.The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve,as well as the changes of symptoms and signs of patients were observed before and after treatment.The clinical effect was evaluated.Results:After treatment,the median nerve MNCV in the three groups,the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups,and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment,with significantly statistical differences(all P<0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group,with significantly statistical differences(all P<0.05).After treatment,the number of patients in the three groups with the symptoms and signs was lower than that of before treatment.The effective rate in combination group was 96.8%(30/31),higher than those of western medication group,74.2%(23/31),and acupuncture group,83.8%(26/31),with significantly statistical differences(both P<0.05).Conclusion:Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients,with a better effect than those of western medication and simple acupuncture.展开更多
Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF a...Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF and HIF-lα levels of patients. Methods： Ninety-six patients were randomly divided into electroacupuncture treatment group （EA group）, intermittent pneumatic compression treatment group （IPC group）, electroacupuncture combined with intermittent pneumatic compression treatment group （EA ＋ IPC group） and cobamamide group （CM group）, with 24 cases in each group. Electroacupuncture treatment （once a day）, intermittent pneumatic com pression treatment （twice a day） and intramuscular injection with cobamamide （1 rag, once a day） were carried out in EA group, IPC group and CM group, respectively, and intermittent pneumatic compres- sion treatment （twice a day） was conducted on the basis of electroacupuncture treatment （once a day） in EA＋IPC group. After treatment for 2 consecutive weeks, the differences in subjective symptoms, mo- tor nerve conduction velocity, sensory nerve conduction velocity and serum HIF-lα and VEGF levels of patients in the four groups before and after treatment were observed and compared. Results： After treatment for 2 weeks, the differences in total effective rate between EA group and CM group, IPC group and CM group, as well as EA ＋ IPC group and CM group were all significant （all P 〈 0.05）, and the total effective rate in EA＋ IPC group was significantly higher than that in EA group and IPC group （both P 〈 0.05）. After treatment for 2 weeks, the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve of patients in EA group, 1PC group and EA＋IPC group were all higher than that before treatment （all P 〈 0.05）; the motor nerve conduction velocity of median nerve and the sensory nerve conduction velocity of common peroneal nerve in EA group were all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve in IPC group were also all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve in EA＋IPC group were all higher than that in CM group （both P 〈 0.05）; the sensory nerve conduction velocity of common peroneal nerve in EA ＋ 1PC group was higher than that in EA group and IPC group （both P 〈 0.05）, and the motor nerve conduction velocity of median nerve in EA＋IPC group was higher than that in IPC group （P 〈 0.05）. The serum HIF-1α and VEGF levels of patients in EA group, IPC group and EA ＋ IPC group after treatment significantly reduced （all P 〈 0.05）. and were lower than that in CM group after treatment （all P 〈 0.05）; the serum HIF-lα and VEGF levels of patients in EA ＋ IPC group after treatment were lower than that in EA group and IPC group, and the difference in serum HIF-lα level was statistically significant （both P 〈 0.05）. Conclusion： Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus can effectively improve the clinical symptoms of patients with diabetic peripheral neuropathy, the efficacy were better than electroacupuncture, intermittent pneumatic compression treatment and cobamamide.展开更多
Currently, the population percentage of diabetics suffering Diabetic Peripheral Neuropathy (DPN) and foot-drop gait anomaly was estimates as 15% in the United States. The onset of foot-drop could not be detected until...Currently, the population percentage of diabetics suffering Diabetic Peripheral Neuropathy (DPN) and foot-drop gait anomaly was estimates as 15% in the United States. The onset of foot-drop could not be detected until symptoms could be observed visually, patient falling or patient experiencing painful gait issues and expensive medical tests. This research showed that by utilizing the plantar-pressure characteristics of DPN drop-foot gait, a set of index could be developed for the severity of DPN.展开更多
Pharmaceuticals targeting the pathogenesis of diabetic distal symmetric polyneuropathy have all failed in clinical trials, limiting recourse to palliative treatments. The American Diabetes Association regards the effe...Pharmaceuticals targeting the pathogenesis of diabetic distal symmetric polyneuropathy have all failed in clinical trials, limiting recourse to palliative treatments. The American Diabetes Association regards the effectiveness of glycemic control and lifestyle modification therapies on diabetic neuropathies as inconclusive. The objective of this research was to determine if and how physical exercise influences distal symmetric polyneuropathic severity in type 2 diabetes patients. Embase, MEDLINE, and Google Scholar were searched to collect randomized and controlled studies published between January 1, 2012 and April 20, 2020. Titles had to mention diabetes, physical exercise of any type or lifestyle interventions in general, and neuropathy. Abstracts had to indicate satisfaction of PICOS criteria, whereas full-text reviews had to be fully confirmatory. Extracted data was thematically synthesized based primarily on relationships between exercise interventions and effects on distal symmetric polyneuropathic severity outcomes in type 2 diabetes patients. Qualitative analysis scoring criteria objectively mirrored PICO except for the bias and limitation score component, which assessed common markers of validity for randomized trials (as specified in the PRISMA statement). Database searches yielded 379 unique records, 15 of which passed eligibility screening. Thematic synthesis supported exercise as an ameliorative treatment of type 2 diabetes distal symmetric polyneuropathy through improved Michigan Diabetic Neuropathy Scores and increased sural sensory nerve conduction velocity, though efficacy may be limited by neuropathic severity. This is the first systematic review to acquire these results, and to do so within the context of neuropathic severity. This review protocol is registered on PROSPERO (CRD42020181211) at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020181211展开更多
文摘Introduction: Vitamin B complex has been used for peripheral neuropathy for a long time and continues to be part of current practice despite lack of strong evidence for its use and its non-inclusion in treatment guidelines. Objective: To determine the clinical and neurophysiological effects of 1500 μgm/day of oral methylcobalamin among subjects with diabetic polyneuropathy. Methodology: We conducted a prospective, open-label study on adult diabetic subjects with polyneuropathy who were given 1500 μgm/day of oral methylcobalamin over 24-weeks. The primary outcome measure was the Toronto Clinical Scoring System (CSS) and secondary measures were Subjective Impression of Change, Clinicians Impression of Change and neurophysiological parameters. Results: Out of forty eight subjects, thirty seven completed treatment and twenty one agreed to have repeat neurophysiologic study post-treatment. At the end of treatment, there was a significant decline in the Toronto CSS score (p < 0.0001) indicating improvement. This was observed across all stages of severity and in any duration of diabetes whether more or less than 10 years. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling (p < 0.03), upper limb symptoms (p < 0.003), ataxia (p < 0.004), and signs of impaired position (P < 0.009) sense, vibration sense (p < 0.0001), pinprick sensation (p < 0.004) and knee reflex (p < 0.004). No significant improvement was seen in the secondary outcomes (both p=0.06) except for ulnar nerve amplitude and distal latency. Conclusion: This 24-week open label study demonstrated that symptoms of diabetic polyneuropathy significantly improved among subjects given methylcobalamin 1500 μgm/day and new symptoms did not emerge over the 24 week observation period. Larger controlled trials are needed to corroborate these findings.
文摘Background: The distal sensory polyneuropathy (DSP) was more frequent among diabetics, although its determinant was not well known among diabetics in Benin. Objective: We aimed to assess the frequency of DSP and its determinants among diabetics at Parakou. Methods: It was a cross-sectional study carried out from 1 March to 31 August 2012 and included 336 diabetics followed at the diabetes unit of Parakou hospital. The diagnosis of DSP was based on DNS (Diabetic Neuropathy Score) criteria and other criteria. All data concerning the diabetes mellitus were recorded. We used Epi-Info and SPSS 16.0 software to perform analysis. Results: They were 187 females (56.0%) with the mean age of 54.9 ± 10.9 years. 298 patients fulfilled criteria for DSP;the overall prevalence of DSP was 88.7%. The main associated factors in multivariate analysis were treatment duration of diabetes more than 4 years: OR = 36.7 [4.0 - 336.9];the elevated glycaemia: OR = 3.1 [1.4 - 7.1];the activity with high income: OR = 0.2 [0.0 - 0.8];the ethnicity: nagots/fon: OR: 3.7 [1.4 - 12.5]. Conclusion: Those results suggested the high frequency of DSP among diabetics at Parakou.
文摘BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined with a health-promoting program,can improve the signs and symptoms of diabetic polyneuropathy,enhance gait,res-tore mobility in the foot and ankle joints,redistribute pressure while walking,and increase foot strength and function.As a result,these exercise programs can help mitigate the risk factors for diabetic foot ulceration.AIM To determine the effect of supervised stretching,strengthening,functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.METHODS This was a randomized controlled trial conducted in a tertiary hospital.The study included 82 participants allocated into the intervention group(alpha-lipoic acid and exercise on 15 consecutive therapeutic days,n=42)and control group(alpha lipoic acid only,n=40).Muscle strength included dorsal and plantar flexors dynamometry and strength score,while range of motion included ankle,subtalar and first metatarsophalangeal joint goniometry.RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15(9.9±7.2 vs 0.1±3.3;P=0.006)and month 6(2.8±7.3 vs-0.9±4.1;P<0.001),subtalar joint on day 15(7.5±5.1 vs-0.25±2.25;P<0.001)and month 6(3.9±6.4 vs-0.13±3.49;P<0.001).Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15(2.62±1.69 vs 0.10±1.35;P<0.001)and month 6(0.66±2.38 vs-0.75±1.94;P=0.004)as well as plantar flexors on day 15(3.3±1.6 vs 0.3±1.5;P<0.001)and month 6(1.8±2.2 vs-0.9±2.1;P<0.001).Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15(-1.45±1.42 vs-0.03±0.16;P<0.001)and month 6(-1.17±1.53 vs 0.20±0.56;P<0.001).CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility,as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.
基金Zhangjiakou Science and Technology Research Plan:1321111D。
文摘Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patients were randomized into western medication group,acupuncture group,and combination group,with 31 cases in each.The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets.The patients in acupuncture group were treated with acupuncture,and the acupoints were selected according to the symptoms.The needles were retained for 30 min,once a day.The patients in combination group were treated with both western medication and acupuncture,specific methods as the above.The treatments were for 18 days in succession in all of three group.The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve,as well as the changes of symptoms and signs of patients were observed before and after treatment.The clinical effect was evaluated.Results:After treatment,the median nerve MNCV in the three groups,the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups,and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment,with significantly statistical differences(all P<0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group,with significantly statistical differences(all P<0.05).After treatment,the number of patients in the three groups with the symptoms and signs was lower than that of before treatment.The effective rate in combination group was 96.8%(30/31),higher than those of western medication group,74.2%(23/31),and acupuncture group,83.8%(26/31),with significantly statistical differences(both P<0.05).Conclusion:Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients,with a better effect than those of western medication and simple acupuncture.
文摘Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF and HIF-lα levels of patients. Methods： Ninety-six patients were randomly divided into electroacupuncture treatment group （EA group）, intermittent pneumatic compression treatment group （IPC group）, electroacupuncture combined with intermittent pneumatic compression treatment group （EA ＋ IPC group） and cobamamide group （CM group）, with 24 cases in each group. Electroacupuncture treatment （once a day）, intermittent pneumatic com pression treatment （twice a day） and intramuscular injection with cobamamide （1 rag, once a day） were carried out in EA group, IPC group and CM group, respectively, and intermittent pneumatic compres- sion treatment （twice a day） was conducted on the basis of electroacupuncture treatment （once a day） in EA＋IPC group. After treatment for 2 consecutive weeks, the differences in subjective symptoms, mo- tor nerve conduction velocity, sensory nerve conduction velocity and serum HIF-lα and VEGF levels of patients in the four groups before and after treatment were observed and compared. Results： After treatment for 2 weeks, the differences in total effective rate between EA group and CM group, IPC group and CM group, as well as EA ＋ IPC group and CM group were all significant （all P 〈 0.05）, and the total effective rate in EA＋ IPC group was significantly higher than that in EA group and IPC group （both P 〈 0.05）. After treatment for 2 weeks, the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve of patients in EA group, 1PC group and EA＋IPC group were all higher than that before treatment （all P 〈 0.05）; the motor nerve conduction velocity of median nerve and the sensory nerve conduction velocity of common peroneal nerve in EA group were all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve in IPC group were also all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve in EA＋IPC group were all higher than that in CM group （both P 〈 0.05）; the sensory nerve conduction velocity of common peroneal nerve in EA ＋ 1PC group was higher than that in EA group and IPC group （both P 〈 0.05）, and the motor nerve conduction velocity of median nerve in EA＋IPC group was higher than that in IPC group （P 〈 0.05）. The serum HIF-1α and VEGF levels of patients in EA group, IPC group and EA ＋ IPC group after treatment significantly reduced （all P 〈 0.05）. and were lower than that in CM group after treatment （all P 〈 0.05）; the serum HIF-lα and VEGF levels of patients in EA ＋ IPC group after treatment were lower than that in EA group and IPC group, and the difference in serum HIF-lα level was statistically significant （both P 〈 0.05）. Conclusion： Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus can effectively improve the clinical symptoms of patients with diabetic peripheral neuropathy, the efficacy were better than electroacupuncture, intermittent pneumatic compression treatment and cobamamide.
文摘目的在中国汉族2型糖尿病患者中探讨皮肤自发荧光(skin autofluorescence,SAF)与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)之间的关系。方法2015年12月至2016年6月从上海市静安区医联体慢病管理库中纳入资料完整的115名2型糖尿病患者。所有纳入者均进行SAF检查及神经传导功能检查(nerve conduction studies,NCS),并根据NCS的检查结果分为DPN组和非DPN组。结果115名2型糖尿病患者中,DPN组39人,非DPN组76人。DPN组SAF测量值为(2.67±0.45)AU,显著高于非DPN组的( 2.28 ±0.41)AU( P <0.001)。根据SAF测量值的第25百分位数和第75百分位数将所有纳入者分为低、中、高SAF组,NCS检查参数包括运动神经传导速度、感觉神经传导速度、远端潜伏期和感觉神经动作电位波幅,3组间差异有统计学意义( P <0.05)。Logistic回归分析显示,SAF为DPN的独立危险因素(OR=8.947,95%CI:1.675~47.793, P =0.010)。ROC曲线显示SAF诊断DPN的曲线下面积为0.726 (95%CI:0.630~0.821, P < 0.001 )。结论SAF为DPN的独立危险因素,对中国汉族2型糖尿患者中DPN患病风险筛查可能存在一定的价值。
文摘Currently, the population percentage of diabetics suffering Diabetic Peripheral Neuropathy (DPN) and foot-drop gait anomaly was estimates as 15% in the United States. The onset of foot-drop could not be detected until symptoms could be observed visually, patient falling or patient experiencing painful gait issues and expensive medical tests. This research showed that by utilizing the plantar-pressure characteristics of DPN drop-foot gait, a set of index could be developed for the severity of DPN.
文摘Pharmaceuticals targeting the pathogenesis of diabetic distal symmetric polyneuropathy have all failed in clinical trials, limiting recourse to palliative treatments. The American Diabetes Association regards the effectiveness of glycemic control and lifestyle modification therapies on diabetic neuropathies as inconclusive. The objective of this research was to determine if and how physical exercise influences distal symmetric polyneuropathic severity in type 2 diabetes patients. Embase, MEDLINE, and Google Scholar were searched to collect randomized and controlled studies published between January 1, 2012 and April 20, 2020. Titles had to mention diabetes, physical exercise of any type or lifestyle interventions in general, and neuropathy. Abstracts had to indicate satisfaction of PICOS criteria, whereas full-text reviews had to be fully confirmatory. Extracted data was thematically synthesized based primarily on relationships between exercise interventions and effects on distal symmetric polyneuropathic severity outcomes in type 2 diabetes patients. Qualitative analysis scoring criteria objectively mirrored PICO except for the bias and limitation score component, which assessed common markers of validity for randomized trials (as specified in the PRISMA statement). Database searches yielded 379 unique records, 15 of which passed eligibility screening. Thematic synthesis supported exercise as an ameliorative treatment of type 2 diabetes distal symmetric polyneuropathy through improved Michigan Diabetic Neuropathy Scores and increased sural sensory nerve conduction velocity, though efficacy may be limited by neuropathic severity. This is the first systematic review to acquire these results, and to do so within the context of neuropathic severity. This review protocol is registered on PROSPERO (CRD42020181211) at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020181211
