Electroacupuncture in glycemic control: Transitioning from clinical controversies to potential basic research

Diabetes is a major global metabolic disorder, with the type 2 diabetes mellitus (T2DM) population in China expected to reach 168 million by 2050. Electroacupuncture (EA) and auricular acupuncture represent safe, accessible, and multi-targeted strategies for glycemic control with strong translational potential. Clinical studies indicate that EA, targeting trunk and limb acupoints, can significantly reduce fasting plasma glucose and glycated hemoglobin. Mechanistically, EA modulates the neuro-endocrine-immune axis, regulates gut microbiota, and activates insulin signaling pathways. Auricular acupuncture, through vagal innervation, may also exert rapid effects on glucose homeostasis via autonomic modulation. The review's objective is to synthesize and critically evaluate current clinical trials and animal studies on EA and auricular acupuncture for glycemic control in diabetes, particularly T2DM, and to highlight translational implications, mechanistic insights, and evidence gaps. This review also emphasizes translational considerations by highlighting species differences between rodents and humans - an underappreciated yet critical factor influencing the clinical applicability of preclinical findings. Through the integration of recent research advances, the present review not only consolidates clinical and preclinical evidence but also advances a deeper mechanistic framework and underscores the importance of species-specific factors in bridging experimental research and patient care. Future progress requires rigorously designed, adequately powered, multicenter randomized controlled trials with standardized protocols to validate efficacy and define their role in precision diabetes management.