Acupuncture

Acupuncture has been practiced for thousands of years in China to treat a wide variety of diseases, including diabetes. It this section we discuss the literature concerning acupuncture studied in patients with diabetes mellitus.

Acupuncture originated in China over 2000 years ago. Acupuncture derives from the Latin words ‘Acu’ (needle) and ‘Punctus’ (to puncture)[1]. Needling takes place at specific points, acupuncture points, to regulate the ‘Qi’ circulation. There are about 400 acupuncture points and 20 meridians connecting most of the points [2]. It is believed that by stimulating of a selection of these acupuncture points the Qi circulation will get in motion, resulting in the recovery of the Qi and subsequently body functions [1][3].

Besides acupuncture with needling, a variety of acupuncture therapies are described; e.g. electroacupuncture (EA), moxibustion, laser acupuncture, auriculoacupuncture, acupressure, and cupping [1]. With EA, the same acupuncture points are stimulated, however with the addition of administering electric pulses [4]. Moxibustion is a technique that applies heat to acupoints by burning compressed powdered herbal material [5]. With Laser acupuncture, the stimulation of traditional acupuncture points is done with low power lasers [6]. Auriculoacupuncture means ear acupuncture; needling takes place at ear points [7]. With acupressure, acupoints are stimulated by pressure instead of needles [8]. And finally, cups with vacuum are used on acupressure point with cupping [9].

We only describe acupuncture with needling and electroacupuncture, because this techniques are predominantly described in literature regarding to diabetes.

Evidence

First, the Cochrane library was searched for a meta-analysis on acupuncture and diabetes. One protocol was published to assess the effects of acupuncture in patient with type 2 diabetes mellitus [10]. Unfortunately, the results of this meta-analysis are not published at the time of this publication. Also, no records were found in the TRIP database and on clinical evidence. On Pubmed, several reviews have discussed the effects of acupuncture in diabetes. One review described three studies; these studies showed significant decrease of fasting blood glucose, and oral glucose tolerance in patients with diabetes treated with acupuncture. Increased anaerobic cellular glucose metabolism, changes in insulin-dependent regulation, and increase of insulin sensitivity are mentioned to be the explanation for the improvement of the blood glucose values [3]. A review published about EA for control of blood glucose in diabetes described the hypoglycemic effect of EA in mainly animal studies [4].

Besides reviews about the effect of acupuncture on glucose metabolism, also reviews about diabetic complications were published [11][12][13]. A review about manual acupuncture and diabetic peripheral neuropathy, described a beneficial effect of manual acupuncture for diabetic peripheral neuropathy, but because of the poor methodology of the included randomized clinical trials, no clinical relevant conclusions can be drawn from this review [11]. Also, a meta-analysis regarding the effect of acupuncture and diabetic gastroparesis was published [13]. All studies were assessed by the GRADE system and were assessed as low and very low quality. Because of the low methodological quality of the included trials no definite conclusion on the effect of acupuncture on diabetic gastroparesis could be drawn. A study that assessed the quality of reports regarding acupuncture treatment and diabetic peripheral neuropathy showed that in almost every randomized controlled trial the description of methods and design were incomplete [12].

An electronic search using PubMed (19 June 2015) identified 350 publications a. A total of 18 abstracts [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] were selected, of which 7 studies [19][23][24][26][28][29][30] were written in the Chinese language. As only one English abstract was available of these Chinese publications, assessing methodology of most of these articles was not feasible. A small number of studies were performed on humans; most studies were performed on animals. Finally, most studies described only EA instead of manual acupuncture.

Different animal studies (rats) investigated the role of acupuncture on plasma glucose levels [14][16][19][21][25]. All of these studies described a decrease of blood glucose levels after treatment with EA. A possible explanation mentioned is the enhanced secretion of β-endorphin stimulated by EA, which causes increased secretion of insulin and a decrease of blood glucose levels [14]. Because we are mainly interested in the effects of acupuncture in diabetic patients we will describe the human studies more elaborate.

Only a few studies investigated the effect of acupuncture on plasma glycosylated hemoglobin (HbA1c) in humans [17][23][24][26]. All of these studies applied the acupuncture on different acupoints. Two studies described the effect of EA on HbA1c, and both reported beneficial effects [23][24]. The study by Meng et al, amongst 120 outpatients with impaired glucose tolerance, investigated EA in a randomised study. They investigated the clinical efficacy of EA at different frequencies; the patients were randomly divided into control, EA-5 Hz, EA-50 Hz, and EA-100 Hz groups for 60 sessions. It is unknown which intervention was performed in the control group. Fasting blood glucose and HbA1c were detected during the study. HbA1c was significantly lower in the EA-5 Hz group than those of the control group (P<0.05) and also significant lower than those of pre-treatment in the same group (P<0.01) [23]. In another study by Meng et al, amongst patients with impaired glucose tolerance, EA versus a control group without intervention were randomly divided and the effect of EA on HbA1c and fasting glucose was investigated. HbA1c was down-regulated in the EA group and superior to the control group after 6 sessions of EA [24]. Methodology and results were only described in Chinese, therefore only an English abstract was checked. No information regarding baseline characteristics, results and statistics were available.

Complications of Acupuncture

Inadequate sterilization of needles or inadequate treatment can cause local pain, inflammation, hematoma or infection [32][33]. Minor and major adverse events have been described. In a German study published in 2004, although the prevalence is low, the most frequent mentioned serious adverse event was a pneumothorax (no. 2 out of 97.733 patients). In this study needling pain and hematoma during treatment were most common seen, respectively 3.28% and 3.19% [32]. In immunocompromised or poorly controlled diabetic patients very rare major complication like necrotizing fasciitis, abscess formation, and bacteremia were described in case-reports [3][34][35][36][37].

Conclusion

Different studies, mostly animal studies, showed beneficial effect of acupuncture on blood glucose or HbA1c. However, it is not possible to draw any definite conclusions as only abstracts were available or studies had a poor methodological quality. Well-designed randomized controlled trials are needed to draw definitive conclusions regarding the effect of acupuncture on diabetes.

References

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  8. ^ Hsiung WT, Chang YC, Yeh ML, Chang YH. Acupressure improves the postoperative comfort of gastric cancer patients: A randomised controlled trial. 20150608(1873-6963 (Electronic)).

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