ROLE OF CORTICOSTEROIDS IN THE MANAGEMENT OF DIABETIC CRANIAL NERVE PALSY: A SYSTEMATIC REVIEW

Abstract

This systematic review examined the published evidence on the efficacy and safety of corticosteroid regimens in adult patients with diabetic cranial nerve palsy (DCNP). The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Embase, Scopus, the Cochrane Library, and Web of Science identified 14 eligible studies published between January 2020 and March 2025. The included studies comprised prospective and retrospective observational studies, cohort studies, and one systematic review with meta-analysis. The clinical question was developed using the PICO framework, and the methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale and AMSTAR 2. The included studies consistently reported that diabetic cranial nerve palsy is generally a self-limiting condition, with most patients achieving spontaneous recovery within 6–12 weeks following conservative management. Several studies described modest short-term symptomatic improvement with corticosteroid therapy, including earlier resolution of diplopia and reduction of perineural oedema. However, the available evidence did not demonstrate a consistent or statistically significant improvement in long-term neurological or functional outcomes compared with conservative management. Reported adverse effects of corticosteroid therapy included steroid-induced hyperglycaemia, elevated HbA1c levels, hypertension, and weight gain. Overall, the evidence reviewed suggests that routine corticosteroid therapy cannot currently be recommended for diabetic cranial nerve palsy because the available studies do not demonstrate a clear long-term clinical benefit, and the condition is believed to be predominantly ischaemic rather than inflammatory. Further high-quality, adequately powered randomised controlled trials are required to clarify the efficacy and safety of corticosteroid therapy in this condition.