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Effect and Safety of Acupuncture for Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of 21 Randomised
Shu-Qing Li1, Jian-Rong Chen2, Mei-Lu Liu3
1Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, China.
Objective:
To evaluate the effects of acupuncture on hypoglycaemic outcomes in type 2 diabetes mellitus (T2DM).
Methods:
PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched from inception up to July 2020, to identify randomised controlled trials (RCTs) that enrolled patients with T2DM and compared acupuncture combined with antidiabetic drugs to antidiabetic drugs alone. The primary outcomes were haemoglobin A1c (HbA1c) and fasting blood glucose (FBG). The secondary outcomes included 2-h blood glucose (2hBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR), and acupuncture-related adverse events. Mean difference (MD) and 95% confidence interval (CI) were used as the effect measure in the meta-analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.
Results:
Twenty-one RCTs (n=1,188) were included. The meta-analytic results showed that the acupuncture group had greater reductions in FBG (MD -6.46 mg/dL, 95% CI -11.95 to -0.98; moderate-quality evidence) and HOMA-IR (MD -1.23, 95% CI -2.16 to -0.31; low-quality evidence), but comparable changes in HbA1c (MD -0.39%, 95% CI -0.84 to 1.61; very-low-quality evidence), 2hBG (MD -4.99 mg/dL, 95% CI -20.74 to 10.76; low-quality evidence), and FINS (MD -1.32 µIU/mL, 95% CI -3.76 to 1.12; low-quality evidence). No data on the incidence of diabetic complications were found. All acupuncture-related adverse events reported were mild.
Conclusions:
The current evidence suggests that acupuncture, as a complementary therapy to antidiabetic drugs, has a small but statistically significant effect on decreasing FBG and improving insulin resistance. The effects of acupuncture on HbA1c, 2hBG, and FINS remain uncertain. Acupuncture is generally safe in patients with mild diabetes. More evidence for the long-term effects of acupuncture on T2DM is needed. (Trial registration No. CRD42018115639).
Insights
Acupuncture shows a modest benefit in lowering fasting blood glucose and improving insulin resistance for type 2 diabetes. However, its effects on HbA1c and other markers are uncertain, with mild adverse events reported.
Area of Science:
- Integrative and Complementary Medicine
- Endocrinology and Metabolism
- Clinical Research
Background:
- Type 2 diabetes mellitus (T2DM) is a global health concern requiring effective management strategies.
- Acupuncture is a traditional therapy explored for its potential role in managing metabolic disorders like T2DM.
- Evaluating acupuncture's impact on glycemic control and insulin sensitivity is crucial for evidence-based practice.
Purpose of the Study:
- To systematically evaluate the effects of acupuncture as an adjunct therapy for hypoglycaemic outcomes in T2DM patients.
- To assess acupuncture's impact on key glycemic control markers, including HbA1c and fasting blood glucose (FBG).
- To analyze secondary outcomes such as insulin resistance and adverse events associated with acupuncture treatment.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) was conducted, searching major databases up to July 2020.
- Included studies compared acupuncture plus antidiabetic drugs versus antidiabetic drugs alone in T2DM patients.
- Primary outcomes were HbA1c and FBG; secondary outcomes included 2-h blood glucose (2hBG), fasting insulin (FINS), and HOMA-IR. Evidence quality was assessed using GRADE.
Main Results:
- Twenty-one RCTs involving 1,188 patients were analyzed.
- Acupuncture significantly reduced FBG (moderate-quality evidence) and HOMA-IR (low-quality evidence).
- No significant differences were observed in HbA1c (very-low-quality evidence), 2hBG, or FINS. Reported adverse events were mild.
Conclusions:
- Acupuncture, as a complementary therapy for T2DM, demonstrates a statistically significant, albeit small, effect in reducing FBG and improving insulin resistance.
- The impact of acupuncture on HbA1c, 2hBG, and FINS requires further investigation due to uncertain evidence.
- Acupuncture appears safe for patients with mild T2DM, but more research on long-term effects is warranted.
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