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Important limitations of the current evidence include: Most trials have been relatively small and of short duration (typically 816 weeks) Study quality varies, with some trials lacking robust blinding or having high dropout rates Publication bias may exist, with negative studies less likely to be published Long-term safety and efficacy data beyond three months are scarce Few studies have been conducted in Western populations or UK healthcare settings The National Institute for Health and Care Excellence (NICE) does not include berberine in its guidelines for diabetes management (NG28), reflecting the lack of sufficient high-quality evidence to support its routine use

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Nerve Growth Factor (NGF) plays a complex role in DPN, with preclinical studies highlighting its therapeutic potential and clinical trials revealing mixed outcomes

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