Immediate Effect Of Needling At Weiwanxiashu Point(EX-B3) On Blood Glucose Level In Patients With T2DM

Background:Diabetes as a major global health problem is defined as a chronic disease characterized by an increased level of glucose in blood.It occurs when the body is unable to transport glucose to the inside of cells.Thus,the level of glucose in the blood is too high,whilst cells starve to death.Diabetes can be fatal condition and often leads to disability and damage to organs,blood vessels,and nerves.High blood sugar is the main symptom of the disease.The percentage of people with diabetes is rising rapidly as obesity increases.Complications of diabetes include blindness,heart disease,circulation problems,kidney disease,eye disease,and erectile dysfunction.There are three primary types of diabetes.In type-1 diabetes the insulin producing cells in the pancreas have been damaged by the body's immune system.Type-1 diabetics are unable to produce insulin and require insulin injections.Approximately 10%of diabetes cases are type-1.Type-2 or "adult-onset"diabetes comprises 90%of diabetes cases.Type-2 diabetes occurs when the body is unable to utilize insulin or produce enough insulin to control blood sugar levels.This leads to unbalanced blood sugar levels and symptoms including excessive thirst and urination,fatigue,and strong hunger,among other symptoms.Oral hypoglycemic drugs,dietary changes,exercise,and stress management are the primary forms of treatment.There can be side effects of diabetic drugs and they are often not effective at minimizing complications.Many patients cannot use them due to side effects.Gestational diabetes is usually a temporary condition that affects up to 5%of pregnancies.Gestational diabetes increases the diabetes risk for the child and the mother.In China acupuncture and herbal medicine are used with traditional Western diabetes drugs.The combination of Western,acupuncture and Chinese medicine treatments for diabetes is more effective than either on their own.Chinese herbs and acupuncture treatments can help to reduce pharmaceutical medication dosages and reduce the side effects.Acupuncture is effective at controlling blood sugar levels,reducing appetite and thirst,improving blood flow and circulation,and preserving nerve function.According to Chinese etiology and pathogenesis there are commonly used acupuncture points that help to control blood sugar levels.Weiwanxiashu point(Ex-B3)is an empirical acupoint for treating diabetes effectively.The hypoglycemic effect of this acupoint first depends on the increase of insulin,suggesting that Weiwanxiashu can improve the function of beta cells in pancreas gland,and probably relieve insulin resistance on target cells that expedites the utilization of glucose.resulting in lowering of blood sugar.Objectives:evaluation of immediate effect of needling at Weiwanxiashu point(EX-B3)on blood glucose level in patients with T2DM.Methods and Materials:This pilot study was a clinical trial performed from June 2018 to November 2018 in a private clinic in Tehran,Iran.Thirty three known diabetic patients invited to clinic and asked them about their disease and drug history.Among 33 invited patients 24 patients have met inclusion criteria(Known case of T2DM,aged between 25 and 75 years either sex,who were in stable condition with only metformin as an oral hypoglycemic drug)and 9 patients didn't have inclusion criteria(using different kinds of medication).Exclusion criteria included history of T2D complications,any acute or unstable sever diseases,malignancy,pregnancy,mental illnesses and whom their medication were other kinds of hypoglycemic drugs except metformin.During second day(intervention day)four patients did not continue the study because of stress.Finally 20 cases completed the study;including 9males(45%)and 11 females(55%),with an average age of 56.35 years.The youngest patient was 38 years old and the oldest 75 years old and the course of disease was 1-16 years with an average of 4.15 years.Most of the participants were overweight with an average BMI = 29.34.The participants only use one kind of oral hypoglycemic drug(metformin)with an average of 1125 mg per day.This study was done in two steps as follow:Step one:On the first day,the OGTT(Oral Glucose Tolerance Test)with 50 grams glucose was performed for participants without any intervention.At first,FBG(Fasting Blood Glucose)was measured as baseline blood glucose level in all the participants who were fasted overnight(water is allowed)for 8-12 hours prior to the tests.Then the patients were given 50 grams of glucose solution to drink and the blood glucose levels were measured again 60 min and 120 min later.Step two:On the second day(intervention day),the OGTT was repeated exactly like the previous day but after drinking 50 grams glucose,participants received needling at Weiwanxiashu(EX-B3)during the first hour of OGTT.Needling was performed bilaterally at Weiwanxiashu(EX-B3);on the back level with the inferior border of the spinous process of the eight thoracic vertebras,1.5 cun lateral to the posterior midline,obliquely toward the spinal column at an angle of 45 degrees by using sterile filiform needles with 0.30 mm diameter and 40 mm length(Beijing Zhongyan Taihe Medical Instrument CO.,Ltd.).The participants received only one session of acupuncture for duration of 30 minutes.Manipulation technique was even method without any other intervention like EA(Electro Acupuncture)or moxibustion.Then the blood glucose level assessed on first and second hour.During the study participants continued their medication as before.Results:Blood samples for(OGTT)were taken from the participant's index fingers and evaluation of blood glucose levels were performed by an objective measurement using with the test strip and a portable glucose meter ACCU-CHEK ACTIVE.Final data were imported and analyzed by an expert medical statistician who was blinded to study grouping.Statistical analysis was performed using SPSS version 20.0 for Windows.Analysis of mean value of blood glucose level demonstrated no significant difference at one hour after 50 gram glucose on 1si and 2nd day.Descriptive results showed that the average blood glucose level immediately after thirty minutes of needling during the first hour from the second day(intervention day)(BG2-1=238.00±47.22)decreased 17.18%from the first hour of the first day(without intervention)(BG1-1=269.55±70.85),but these results are not statistically significant(P-value=0.11).The value of the Partial Eta Squared for day effect showed that only2.3%of the blood glucose changes in the first hour from the first day and the first hour from the second day are due to acupuncture,which is negligibleMean value of blood glucose level in the second hour from the second day(intervention day)(BG2-2=179.65±48.59)decreased 5.53%from the second hour of the first day(without intervention)(BG12=192.80±61.19),but this decrease in descriptive results are not statistically significant(P-value=0.45).The value of the Partial Eta Squared for the day effect shows that only0.5%of the blood glucose changes in the second hour from the first day and the second hour from the second day are due to acupuncture,which is negligibleConclusion:The results of this study indicated that 30 minutes of needling at Weiwanxiashu point(EX-B3)seems to lower the blood glucose level immediately;however,it was not statistically significant which could be due to insufficient sample size.It is advisable to have enough samples in several groups to compare the effect of different interventions on Weiwanxiashu point such as:Acupuncture group,Sham Acupuncture group,Electro-acupuncture group,Moxibustion group or some combinations of them to obtain a more accurate result.And it will be better to check other related criteria with blood glucose such as insulin and glucagon levels simultaneously.Therefore,it is essential for further clinical trials to investigate the effects of acupuncture on T2DM.