Comparative evidence on the effectiveness of non-invasive brain and nerve stimulation in diabetic neuropathy: a systematic review and network meta-analysis

Diabetic neuropathy is one of the most common complications of diabetes, characterized by pain and impaired quality of life. Standard pharmacological approaches are often ineffective and accompanied by side effects. This systematic review and network meta-analysis assessed the comparative effectiveness of different types of non-invasive brain and peripheral nerve stimulation (including TENS, tDCS, rTMS, PEMF, etc.) based on 15 RCTs involving 1139 patients. Only TENS showed a statistically significant reduction in pain intensity (SMD = −1.67) and sleep disturbances (SMD = −1.63). High-frequency rTMS over the motor cortex also improved quality of life. None of the interventions increased the risk of study dropout or mortality. The results highlight the potential of TENS in the treatment of diabetic neuropathy and the need for further RCTs to confirm its long-term effectiveness.