Researchers find acupuncture beneficial for diabetic glucose level regulation and for the relief of diabetic gastrointestinal disorders.
Acupuncture alleviates diabetes symptoms. Researchers in two separate studies find acupuncture effective for the relief of diabetes. In one study, Nanjing University of Chinese Medicine researchers find acupuncture combined with moxibustion effective for the relief of a broad variety of diabetes related conditions.
In a second study, researchers conclude that acupuncture effectively reduces or eliminates diabetic gastroparesis. This condition, also referred to as delayed gastric emptying, involves pathologically slow movement of food from the stomach to the small intestine. This is caused by high glucose levels in diabetics that leads to vagus nerve damage, which leads to the inability of the nerve to properly regulate stomach muscles. Acupuncture successfully restores digestive functionality wherein gastroparesis is abated. Importantly, a six month follow-up found acupuncture significantly more effective than two different types of pharmaceutical medications for the treatment of diabetic gastroparesis.
The first study we’ll look at was conducted by Wang et al. at the Nanjing University of Chinese Medicine. The investigators determined that women with type 2 diabetes mellitus significantly responded to a combination of acupuncture and moxibustion. The researchers made distinctions between Traditional Chinese Medicine (TCM) diagnostic patterns in their reporting. For women with yin deficiency, the total effective rate was 84.78%. For women with yang deficiency, the total effective rate was 69.75%. Overall, symptoms decreased and objective measurements document positive physiological outcomes.
In both yin and yang deficiency groups, significant objective measures of improvement were documented. Patients had sustained lower glucose levels, improved sensitivity to insulin, and restoration of islet β-cell functions. Islet β-cell failure is common in diabetics because cells compensate for insulin resistance. Insulin resistance often leads to islet β-cell mass increases to facilitate increased insulin production. However, apoptosis also increases thereby leading to a decrease in overall β-cell volume.
We’ll take a look at the acupuncture point prescriptions used by the researchers and describe how they achieved clinical successes verified by objective measurements. First, let’s examine the background presented in the study. The researchers cited prior investigations, including one by Xu et al. noting that China has a growing population of diabetics. In 1980, 1% of the population in China had diabetes; that rate increased to 7% by 2007.
Traditional Chinese Medicine pattern differentiation was used to create the study group. A total of 93 female patients with both yin and yang deficiency participated in the study. They were divided into two groups; group 1 primarily had yin deficiency and group 2 primarily had yang deficiency. Both groups received simultaneous acupuncture and moxibustion therapy. The primary acupoints selected for acupuncture were the following:
- Pishu (BL20)
- Zhangmen (LV13)
- Weishu (BL21)
- Zhongwan (CV12)
- Ganshu (BL18)
- Qimen (LV14)
- Shenshu (BL23)
- Jingmen (GB25)
- Sanyinjiao (SP6)
- Qihai (CV6)
- Guanyuan (CV4)
- Zusanli (ST36)
- Mingmen (GV4)
- Yishu (Weiguanxiashu, MBW12)
First, acupuncture commenced with the patient resting in a supine position. After standard disinfection, either a 0.30 mm x 40 mm or a 0.30 mm x 0.50 mm disposable filiform acupuncture needle was inserted into each of Zhangmen, Zhongwan, Qimen, Jingmen, Sanyinjiao, Qihai, Guanyuan, and Zusanli. Thereafter, the acupoiunts were manipulated with the Bu (tonify) technique. Once a patient felt soreness, numbness, swelling, or heaviness, the needles were left in position. The sensations were elicited to confirm the arrival of deqi.
Moxa cigars were then affixed to certain acupoints as part of the moxibustion therapy (mentioned below). Next, the needles were subsequently retained for 30 minutes, during which they were manipulated once every 10 minutes. After the 30 minute acupuncture needle retention time, the needles were removed and patients switched to a prone position. An identical acupuncture insertion, manipulation, and retention protocol was administered to acupoints Pishu, Weishu, Ganshu, Shenshu, and Mingmen. Moxibustion was simultaneously administered with the above acupuncture therapy. The acupoints which received moxibustion were the following:
- Qihai (CV6)
- Guanyuan (CV4)
- Zusanli (ST36)
- Mingmen (GV4)
During the aforementioned acupuncture therapy, a 1.5 cm x 1 cm moxa cigar cutting was affixed to the top of the acupuncture needles for the 4 acupoints: CV6, CV4, ST36, GCV4. The moxa was attached by piercing a small hole through the cigar cutting and then attaching it to the top of the needle handle. A protective paper sheet was used to cover the patient’s skin to prevent accidental burning from the moxa cigar. The paper sheet was thin enough to allow heat diffusion from the moxibustion. The combined acupuncture and moxibustion therapy was conducted once every other day for a total duration of 3 months.
The researchers cited Traditional Chinese Medicine (TCM) theory in their research as part of the acupuncture continuing education component of the report. They note that TCM principles indicate that acupoint Sanyinjiao nourishes yin, expels excessive heat, removes blood stasis, benefits the liver, kidneys, and spleen; and enhances qi and blood circulation. Guanyuan nourishes yin and also strongly reinforces yang. This acupoint promotes kidney health, replenishes body fluids, and dredges the meridians. Likewise, Qihai promotes kidney health and strengthens yang. Zusanli is a classic acupoint for replenishing yuan qi, promoting spleen health, improving qi and blood circulation, eliminating phlegm, dredging meridians, and expelling excessive body heat. These principles were the basis for the acupoint selections used in the research clinical protocols.
Once the treatment regimen was completed for all patients, the efficacy of patient outcomes was measured according to symptomatic and objective measures of improvement. This included measurements of the normal fasting blood glucose (FPG) levels. Symptomatic improvements did not count as beneficial outcomes unless the FPG met the criteria. Results were categorized into three tiers using the following criteria:
- Significantly effective: No symptoms. FPG<7.2 mmol/l or ≥30% reduction from pre-treatment levels.
- Effective: Significant improvement in symptoms. FPG between 7.2 – 8.3 mmol/l, or between 10% – 30% reduction from pre-treatment levels.
- Not effective: No improvement in symptoms. Improvement in FPG did not meet standards for the Effective category.
The total treatment effective rate for each treatment group was calculated as the percentage of patients who reported at least an effective treatment efficacy. Upon reviewing the clinical results of the study, the researchers (Wang et al.) determined that acupuncture combined with moxibustion provide significant clinical benefits for women with type 2 diabetes. Notably, a discrepancy between yin and yang deficiency patients indicates that yin deficiency patients have greater positive patient outcomes using the aforementioned acupuncture treatment protocol.
In related research, He et al. performed a meta-analysis to determine the efficacy of acupuncture for the treatment of diabetic gastroparesis (DGP). The study, published in the Journal of Clinical Acupuncture and Moxibustion, demonstrates that acupuncture produces superior patient outcomes when compared with two types of pharmaceutical medications. DGP is a common complication of diabetes and is characterized by a decrease in gastrointestinal motility and gastric dysrhythmia, leading to gastric retention. DGP results in a series of upper gastric discomforts and symptoms, including upper abdominal fullness and pain, belching, anorexia, nausea, regurgitation, diarrhea, or constipation. In addition, gastrointestinal dysperistalsis affects nutrient and hypoglycemic related drug absorption, leading to greater fluctuations in glucose levels. DGP contributes to spikes in glucose levels.
Significant symptoms of DGP are gastric retention and abnormal gastrointestinal motility. Based on this, DGP treatment focuses on relief of gastric retention, maintaining long-term blood glucose regulation, and reinforcing the body’s nutrient supply. Currently, gastroprokinetic drugs are widely used in DGP treatments. However, long-term intake of drugs may lead to adverse effects. By contrast, acupuncture is a readily administered and affordable therapy. For these reasons and because acupuncture is safe and effective, it is increasingly applied to patients with DGP.
He et al. performed a meta-analysis and data review based on 10 previously published clinical studies. To ensure the objectivity of the meta-analysis, a large sample size was reviewed from high quality randomized clinical studies from different sources. The clinical studies involved 755 DGP patients in total. Among the 10 clinical studies, 9 investigated the efficacy of acupuncture versus pharmaceutical medications for the treatment of DGP and 1 study investigated the efficacy of acupuncture versus a placebo in treating DGP. In each study, the treated acupoints, acupuncture techniques, and treatment durations were different. The meta-analysis grouped patients into two groups: treatment and control. The treatment group consisted of the acupuncture groups, while the control group consisted of the pharmaceutical medication and placebo groups.
From the meta-analysis, He et al. conclude that acupuncture is superior to domperidone and cimetidine in terms of improving appetite, reducing bloating, eliminating belching, relieving upper abdominal pain, and relieving nausea and regurgitation. Domperidone is an anti-emetic drug and cimetidine is a histamine blocker used to benefit digestion. Cimetidine is used for many types of treatments including those for GERD (gastroesophageal reflux disease), ulcers of the stomach and small intestine, esophagitis, and related conditions.
The total treatment effective rate of the treatment group was 91.14%, higher than that of the control group, which was 74.14%. No harmful side effects occurred as a result of acupuncture treatment, indicating that acupuncture is a relatively safe treatment. Furthermore, a 6 month follow-up demonstrated that the treatment group had 2 relapses out of 36 cases while the control group had 12 relapses out of 36 cases. This is indicative of the stability and longevity of acupuncture treatment results. The meta-analysis by He et al. highlights the safety and efficacy of acupuncture compared with medications for the treatment of DGP. Across the 10 clinical studies examined in the meta-analysis, acupuncture has been scientifically validated to produce positive, stable, and long-lasting treatment results. The primary investigation by Wang et al. and the meta-analysis by He et al. shed light on the benefits of acupuncture for the treatment of diabetes.
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He H, Li K, Zhang L & Hu MQ. (2015). Systematic Review of Acupuncture in the Treatment of Diabetic Gastroparesis. Journal of Clinical Acupuncture and Moxibustion. 31(8).
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