Reference
Kumar R, Mooventhan A, Manjunath NK. Immediate effect of needling at CV-12 (zhongwan) acupuncture point on blood glucose levels in patients with type 2 diabetes mellitus: a pilot randomized placebo-controlled trial. J Acupunct Meridian Stud. 2017:19(4):240-244.
Study Objective
To examine the effect of needling at CV-12 on random blood glucose (RBG) levels in men with type 2 diabetes (T2D).
Design
Pilot study, randomized, placebo-controlled trial.
Participants
Forty men with T2D, aged 56.2±11.0 years, stable on their medication for the previous 3 months, were randomly assigned to either the treatment (n=20) or placebo (n=20) group. The 2 groups were similar in age, sex, height, weight, and body mass index (BMI). Exclusion criteria included history of T2D complications, needle phobia, and mental illness.
Primary Outcome Measures
Random blood glucose before and after treatment using a portable ACCU-CHEK Active, Performa Nano machine by Roche Diagnostics, Mumbai, India.
Intervention
Participants in the treatment group were needled at CV-12 4 cun (4 times the width of an individual’s thumb at the knuckle) above the center of the umbilicus for 30 minutes to a depth of 0.5 cun using a 0.5 cun filiform locally manufactured copper needle 0.38 mm diameter by 13 mm long. Participants in the placebo group were needled 1 cun lateral of CV-12, where there is no known acupuncture point, with the same type of needle, for 30 minutes. Manual stimulation known as bird pecking, moving the needle up and down, was done for 5 minutes in each group.
Key Findings
Compared to the control group, RBG in the treatment group was slightly higher at baseline (146.1 vs 139.15 mg/dL), and slightly lower following acupuncture (133.85 vs 138.8 mg/dL). The change in RBG from baseline following acupuncture (146.1 vs 133.85 mg/dL) was significant in the treatment group (P<0.001) but not in the placebo group. There was no significant difference between the 2 groups in the change in RGB from baseline following acupuncture.
Practice Implications
The impetus for the present study was a 1999 trial of electroacupuncture in diabetic rats. That study concluded that secretion of endogenous beta-endorphin reduced plasma glucose in an insulin-dependent manner after 30 minutes of electro-acupuncture at CV-12 in normal rats and rats with T2D but not in rats with type 1 diabetes induced by streptozotocin or genetics.1 The glucose-lowering effect was abolished by naloxone in a dose sufficient to block opioid receptors and was not aided by glucagon.
In a study published in 2016, Mohanti et al performed the first human test of the 1999 rat trial in 36 volunteers who had acupuncture at either CV-12 or the sham point described above for 20 minutes without stimulation.2 There was a mild decrease in RBG in the treatment group and a mild increase in RBG in the placebo or sham group, but the results were not statistically significant. The same 3 researchers then performed and published the present study.
Acupuncture can lower blood glucose, given the right point(s) in the right person, but the permanence of lowered blood glucose has yet to be demonstrated in a clinical trial.
In a study published just before the 2016 study by Mohanti et al, researchers performed acupuncture at CV-12, C-10, C-6, C-4, ST-24, TW-5, ST-25, SP-15, and KI-13 3 times per week for 3 weeks in 30 obese participants with T2D and compared their responses to 30 like patients (obese with T2D) who were on medication only.3 In the acupuncture group systolic blood pressure, waist circumference, BMI, fasting blood glucose, 2-hour glucose tolerance test, fasting insulin, total cholesterol, and low-density lipoprotein (LDL) cholesterol were significantly reduced (P<0.05). The total response rate was 93% (28/30) in the acupuncture group and 23% (7/30) in the medication-only group, a significant difference (P<0.01). They did not report whether the effect was lasting.
Other recent studies support the benefits of acupuncture for glucose control in humans. A trial published in 2014 involved 99 obese women with a risk of diabetes.4 They were treated with acupuncture, moxibustion, electroacupuncture, and combinations of the 3 and had significant reductions in body weight (P<0.001), BMI (P<0.001), insulin (P<0.01), and insulin resistance index (P<0.01) compared to sham. Thus there was a significant reduction in their overall risk of developing diabetes.
A research review published in 2010 concluded there was evidence that acupuncture improved insulin resistance.5 Much of the data was animal, but there were some human trial data. The authors called for trials to determine the feasibility of acupuncture to serve as an effective treatment for diabetes.
CV-12 (Zhongwan) is situated on the conception vessel meridian.6 It is traditionally used for issues related to the middle warmer; digestive issues such as pain, bloating, reflux, vomiting, diarrhea, jaundice; digestive issues related to a nervous stomach such as anxiety, insomnia, overthinking, and worry; and issues related to the esophagus. CV-12 is also the front mu point for the spleen.7 Thus it is useful for digestive issues related to overthinking and over worrying. From a chakra perspective, CV-12 is the solar plexus chakra and represents being confident and in control of your life.7 In patients with needle phobia, CV-12 can be treated with moxibustion.
Summary
In 2014 the World Health Organization estimated that diabetes affected 422 million adults worldwide, or 8.5% of the adult population.8 In North America the current incidence is 1 in 10 adults, with that number expected to range from 1 in 3 to 1 in 5 by 2050. In the present study, acupuncture significantly reduced RBG in diabetic men compared to sham acupuncture. It did not reduce RBG to nondiabetic levels and its lasting effect was not assessed. Acupuncture can lower blood glucose, given the right point(s) in the right person, but the permanence of lowered blood glucose has yet to be demonstrated in a clinical trial.3-5 Clinically, acupuncture can be part of a larger treatment protocol for treatment of type 2 diabetes, but it has not been demonstrated to be a cure for diabetes.
Study Limitations
Limitations of the study noted by the authors include its small sample size, inclusion of only male patients, failure to evaluate long-term effects, and measurement of only RBG (vs fasting glucose, postprandial glucose, hemoglobin A1c, or insulin). The additional limitations I identified were the absence of information on the medication(s) participants had been taking for their T2D, including medication types, doses, and duration of treatment, time between the last meal and acupuncture treatment, and the mean fasting glucose reading for the week prior to the trial. In addition, normal and diabetic glucose levels vary by country, and the authors did not report the values used in India. Also, although the authors indicated that the person who provided acupuncture was not the one who randomized or analyzed the data, no individual author is identified with any of these roles.
