Acupuncture Safety in Diabetic Limb: A Scoping Review.

Background: Any injury to the diabetic limbs may portent disastrous consequences. However, it is not uncommon for diabetics to also seek complementary and alternative medicine for treatment, such as acupuncture. There are limited data on infective or ulcerative adverse events regarding acupuncture in diabetic limbs. Objective: This scoping review served to survey and map out the current literature landscape on infective or ulcerative complications, if any, of acupuncture in diabetic limbs and to also identify key gaps in the current literature. Methods: A scoping review was conducted based on the five-step framework by Arskey and O'Malley. The review included a comprehensive search of three databases (PubMed, Medline, and Embase) regarding any reports of adverse events after acupuncture in diabetic limbs. Results: Eight articles were analyzed. Four were case reports, three were clinical trials, and one was a review article. Most of the articles mentioned qualifications for practitioners (except for two articles). Clean needle technique was mentioned only in one article. Three articles highlighted adverse events and possible dangers related to needling in diabetic limbs. The other five articles highlighted no serious adverse events in using acupuncture/needling in diabetic limbs. Conclusions: While there are risks of ulceration and poor healing after acupuncture in diabetic feet, there are also likely benefits like improving neuropathy symptoms and ulcer healing. It is important to optimize safety risk factors such as procedural sterility, avoiding concomitant heat modalities, and ensuring qualified practitioners. Only then can patients benefit from acupuncture treatment for diabetic feet while minimizing complication rates.