Efficacy of Frequency Rhythmic Electrical Modulated System (Frems) in the Treatment of Diabetic Neuropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Publisher Pubmed



Azarboo A¹ ; Fallahtafti P¹ ; Javidan A¹ ; Zareshahi N¹ ; Souri Giglou H¹ ; Moayyed S¹ ; Ghaseminejadraeini A¹ ; Hemmatabadi M² Show Affiliations
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews Published:2025

Abstract

Background: Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management. Methods: Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I2 statistics, with sensitivity analyses and publication bias evaluation. Results: Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to −0.29, I2 = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to −0.21, I2 = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to −0.27, I2 = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to −0.12, I2 = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow. Conclusion: FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration. © 2025 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC)