Type-2 diabetes

Body Fit (circulation; 32,505) - Acupuncture has been featured as an injury solution to sports activities, with a quote included by Olympic cycling champion Chris Hoy who has acupuncture for staying in tip top condition. A quote has also been included by British Acupuncture Council member James Cattermole who explains how acupuncture can not only aid recovery but enhance performance. The British Acupuncture Council website and telephone number have been credited as a place to go to find a practitioner in your area.

Daily Mail (circulation; 2,092,643). Acupuncture has been included in a Mood Booster column as treatment which may help raise levels of endorphins. The British Acupuncture Council has been included as place to find a reputable private practitioner.

The Sheffield Star (circulation; 68,059) - An article about infertility has been featured in the health section focussing on alternative methods to help women conceive. Acupuncture is profiled as an alternative treatment which may release hormones, chemicals and endorphins which aid reproduction. The British Acupuncture Council’s website and telephone number are included as a place to find out more information

Wahanda.com (monthly unique users; 438,398) - A global health, beauty, fitness and wellness resource has profiled the British Acupuncture Council on their website as a place to find a qualified acupuncturist in your area. They have featured the press release online about beating jetlag the traditional Chinese way including the quote from British Acupuncture Council member James Thirlwall. Please click on the link to view the article; http://www.wahanda.com/blog/british-acupuncture-council/beat-jetlag-the-traditional-chinese-way/

Type-2 diabetes

Type-2 diabetes (adult-onset or non-insulin-dependent diabetes) is a common metabolic disorder in which the body is unable to regulate the amount of glucose in the blood. The condition affects nearly 1.5 million people in the UK (Diabetes UK, 2004), and may be undiagnosed in as many as a million more. It develops when insufficient insulin is produced by the body, or when the body’s cells no longer respond to insulin (insulin resistance).

The four common symptoms of type-2 diabetes are: excessive thirst, passing large amounts of urine, tiredness and weight loss. Over time, the high blood sugar levels caused by type-2 diabetes causes damage to blood vessels. This leads to atheroma, which can cause problems such as poor circulation, angina, heart attacks and stroke. It can result in diabetic complications, including eye disorders, nerve damage, foot problems, kidney disease and impotence.

The cause of type-2 diabetes is complex, involving an interplay of genes and environmental factors. It tends to occur in people over 40 and is strongly associated with being overweight.

How acupuncture can help

Chinese medical texts have recognized diabetes as ‘wasting-thirsting’ for thousands of years, relating it to the consumption of too much rich food. Acupuncture therapy is a common approach to treating diabetes in modern China. Research has shown that traditional acupuncture can help manage diabetic symptoms and prevent and manage complications of the disease by:

• Helping to treat obesity (Cho et al, 2009), which is the primary risk factor for developing type-2 diabetes. Weight loss (plus increased physical activity) is more effective than drug therapy for preventing or delaying the development of type-2 diabetes (Knowler et al, 2002).

• Increasing insulin production (Lin et al, 2004) and improving blood sugar regulation (Cabioğlu & Ergene, 2006).

• Improving insulin sensitivity (Chang et al, 2006).

• Improving blood lipid profile (Cabioğlu & Ergene, 2005). Dyslipidaemia is common in patients with type-2 diabetes and is responsible for the atherosclerosis and ensuing cardiovascular morbidity and mortality associated with the disease (Krentz, 2003).

• Improving blood circulation (Tsuchiya et al 2007), thus helping to slow the onset and progression of diabetic circulatory complications.

• Helping manage the pain of diabetic peripheral neuropathy (Jiang et al, 2006; Abuaisha et al, 1998).

• Reducing the stress response (Sakai et al, 2007). Stress hormones such as cortisol cause blood glucose to rise and promote insulin resistance (Purnell et al, 2009). Stress may play a role in the development of the metabolic syndrome (Rosmond, 2005), which often precedes diabetes, as well as increasing the risk of developing type-2 diabetes itself (Eriksson et al, 2008), and that it can increase the severity of the condition (Oltmans et al, 2006).

• Helping with depression (Wang et al, 2008). Depression is common among people with diabetes and affects their quality of life. It may contribute to developing the condition (Carnethon et al, 2007). People suffering from depression may take less good care of themselves, eat less well, drink more alcohol or exercise less. All of these can make type-2 diabetes worse.

Most people use acupuncture as part of an integrated diabetes treatment plan because they are already using Western medication. Acupuncture can be safely and effectively combined with Western biomedicine and other treatments such as relaxation exercises and herbal medicine. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be beneficial. Eating a healthy balanced diet, taking regular physical exercise, reducing stress and maintaining a healthy body weight can help to prevent or delay the onset of type-2 diabetes and slow the progression of the disease. Working with a supportive therapist can help people commit to these positive lifestyle changes.

Full details of research studies into traditional acupuncture treatment for diabetes can be found below:

Research	Conclusion
Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2009 Feb;33(2):183-96.	Systematic review of studies of acupuncture for treating obesity. Analysed pooled results from 31 studies involving 3013 cases. Concludes that acupuncture is an effective treatment for obesity.
Purnell JQ, Kahn SE, Samuels MH, Brandon D, Loriaux DL, Brunzell JD. Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. Am J Physiol Endocrinol Metab. 2009 Feb;296(2):E351-7.	Cohort study investigating the relationship between cortisol production, visceral obesity and insulin resistance. Quantified cortisol production and clearance rates, abdominal fat deposits, insulin sensitivity, and adipocyte gene expression in a cohort of 24 men. Concluded that increased hypothalamic-pituitary-adrenal activity in men promotes selective visceral fat accumulation and insulin resistance.
Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Disord. 2008 Dec;111(2-3):125-34.	Meta-analysis which looked at the most recent clinical studies of acupuncture in the treatment of depression. It analysed the pooled results of eight small randomized controlled trials, comprising a total of 477 subjects and concluded; “acupuncture was an effective treatment that could significantly reduce the severity of disease in the patients with depression”.
Eriksson AK, Ekbom A, Granath F, Hilding A, Efendic S, Ostenson CG. Psychological distress and risk of pre-diabetes and Type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008 Jul;25(7):834-42.	Cohort study looking at the role of psychological stress in pre-diabetes and type-2 diabetes. Followed 2127 Swedish middle-aged men and 3100 women with baseline normal glucose tolerance for up to 10 years. Found that psychological distress (including symptoms of anxiety, apathy, depression, fatigue and insomnia) doubled the risk of pre-diabetes and type-2 diabetes in men.
Sakai S, Hori E, Umeno K, Kitabayashi N, Ono T, Nishijo H. Specific acupuncture sensation correlates with EEGs and autonomic changes in human subjects. Auton Neurosci. 2007 May 30;133(2):158-69.	Experimental study of the effects of acupuncture on the autonomic nervous system in healthy volunteers. Found that acupuncture inhibited activity of the sympathetic nervous system (responsible for the ‘fight or flight’ stress response).
Carnethon MR, Biggs ML, Barzilay JI, Smith NL, Vaccarino V, Bertoni AG, Arnold A, Siscovick D. Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2007 Apr 23;167(8):802-7.	Cohort study looking at the association between depressive symptoms and and type-2 diabetes in older adults. Followed 4681 people for 10 years. Found that older adults who reported higher depressive symptoms were more likely to develop type-2 diabetes.
Tsuchiya M, Sato EF, Inoue M, Asada A. Acupuncture enhances generation of nitric oxide and increases local circulation. Anesth Analg. 2007 Feb;104(2):301-7.	Randomized controlled trial studying the effects of acupuncture on local blood circulation. 20 volunteers underwent a session each of real and sham acupuncture in a single hand and forearm with a 1-wk interval between treatments. Concentration of nitric oxide (NO - a vasodilator) in the plasma from the acupunctured arm was significantly increased. Blood flow in the hand of the acupunctured arm also increased. No changes were observed with sham. Concluded that acupuncture increases the NO level in treated regions and thereby increases local circulation.
Chang SL, Lin KJ, Lin RT, Hung PH, Lin JG, Cheng JT. Enhanced insulin sensitivity using electroacupuncture on bilateral Zusanli acupoints (ST 36) in rats. Life Sci. 2006 Aug 1;79(10):967-71.	Experimental study of the effect of electroacupuncture (EA) on blood glucose and insulin levels in diabetic rats. Found that EA had hypoglycaemic activity and improved glucose tolerance.
Jiang H, Shi K, Li X, Zhou W, Cao Y. Clinical study on the wrist-ankle acupuncture treatment for 30 cases of diabetic peripheral neuritis. J Tradit Chin Med. 2006 Mar;26(1):8-12.	Randomized controlled trial of acupuncture for peripheral diabetic neuropathy. 90 patients were treated with either wrist-ankle acupuncture, whole-body acupuncture, or conventional medical treatment. Both acupuncture groups experienced significantly better results than the conventional medical/control group. Acupuncture was also observed to improve blood sugar and lipid metabolism, and restore the functions of peripheral nerve cells
Oltmanns KM, Dodt B, Schultes B, Raspe HH, Schweiger U, Born J, Fehm HL, Peters A. Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. Eur J Endocrinol. 2006 Feb;154(2):325-31.	Observational study of levels of the stress hormone cortisol in 192 type-2 diabetes patients. Found that the degree of severity of several clinical measures of type-2 diabetes (including blood glucose glycosylated haemoglobin and abdominal mass) correlates with cortisol concentrations.
Cabioğlu MT, Ergene N. Changes in levels of serum insulin, C-Peptide and glucose after electroacupuncture and diet therapy in obese women. Am J Chin Med. 2006;34(3):367-76.	Randomized controlled trial of acupuncture investigating the effects of electroacupuncture (EA) combined with diet on body weight and levels of serum insulin, c-peptide and glucose in obese women. Found that (compared with sham EA+diet), EA+diet was effective in treating obesity and that EA decreased serum glucose levels by increasing serum insulin and c-peptide levels.
Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005 Jan;30(1):1-10.	Review discussing how stress and cortisol secretion play a role in the pathogenesis of role in the metabolic syndrome.
Cabioğlu MT, Ergene N. Electroacupuncture therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. Am J Chin Med. 2005;33(4):525-33.	Randomized controlled trial of acupuncture investigating the effects of electroacupuncture (EA) on serum lipid profile in obese women. Found that decreased total cholesterol, triglyceride, and LDL cholesterol levels by increasing the serum beta endorphin level. Concluded that the lipolytic effect of EA may also reduce the morbidity of obesity by mobilizing the energy stores that result in weight reduction.
Lin JG, Chen WC, Hsieh CL, Tsai CC, Cheng YW, Cheng JT, Chang SL. Multiple sources of endogenous opioid peptide involved in the hypoglycemic response to 15 Hz electroacupuncture at the Zhongwan acupoint in rats. Neurosci Lett. 2004 Aug 5;366(1):39-42.	Experimental study investigating the the hypoglycemic response to electroacupuncture (EA) in rats. Concludes that EA causes an increase in beta-endorphin production by the adrenal gland, which enhances the secretion of insulin, thereby reducing plasma glucose levels.
Diabetes UK. Diabetes in the UK 2004. www.diabetes.org.uk/Documents/Reports/in_the_UK_2004.doc	Report providing statistics and other information about the prevalence of diabetes in the United Kingdom in 2004, who is affected and its impact on society.
Krentz AJ. Lipoprotein abnormalities and their consequences for patients with type 2 diabetes. Diabetes Obes Metab. 2003 Nov;5 Suppl 1:S19-27.	Review of lipoprotein abnormalities in patients with type 2 diabetes and their consequences for cardiovascular disease.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.	Randomized controlled trial comparing a lifestyle-intervention with the use of metformin to prevent or delay the development of type-2 diabetes. 3234 people were either given the drug metformin (850 mg twice daily), or placed on a a lifestyle-modification program with the goals of at least a 7% weight loss and at least 150 minutes of physical activity per week. The lifestyle intervention was significantly more effective than metformin, reducing the incidence of type-2 diabetes by 58% (compared with by 31% with metformin.
Abuaisha BB, Costanzi JB, Boulton AJ.Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract. 1998 Feb;39(2):115-21.	Observational study of acupuncture for peripheral diabetic neuropathy. 46 patients were treated with classical acupuncture over a period of 10 weeks and followed up for up to one year. 77% showed significant improvement in their symptoms with 7 reporting complete elimination of symptoms. 67% of patients who used medications at the start of the study were able to stop or reduce their medications significantly during the follow-up period.

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