| OBJECTIVE:To observe the effects of acupuncture therapy on patients with type 2 diabetes mellitus(T2DM)and determine the regulatory effects of acupuncture on the composition of the gut microbiome.METHODS:57 patients suffering from T2DM were selected for this study and assigned into 2 groups in a randomized fashion.A total of 28 patients served as a control group for this study,whereas the remaining 29 patients in the treatment group were given acupuncture therapy.During their hospitalization period,T2DM patients in both groups were given the standard drug treatment for diabetes,provided with health knowledge education,diet control and appropriate exercise.Only the patients in the treatment group were provided with additional acupuncture therapy,which includes a once per day acupuncture session for 6 times per week up to a total period of two weeks.The fasting blood glucose,2-hours postprandial blood glucose,glycosylated serum protein,glycosylated hemoglobin and quantitative points of traditional chinese medicine(TCM)symptoms the patients in both groups were recorded before and after their respective treatments.Fecal samples were also collected before and after the treatments from all the patients in this study.By utilizing the Illumina HiSeq 2500 platform,the high-throughput 16S rDNA amplicon sequencing and clustering method was used to assess the microbial diversity within the fecal samples obtained.All statistical analysis were performed using the SPSS22.0 statistical software.RESULTS:Both groups of patients showed high level of fasting blood glucose,2-hours postprandial blood glucose,glycosylated serum protein and glycosylated hemoglobin before the treatments.There were no significant differences in the initial value of clinical indicators between both the control and treatment group(P>0.05).After two weeks of treatment,the fasting blood glucose,2-hours postprandial blood glucose and glycosylated serum protein level of the patients from both groups decreased significantly(P<0.05).Although the T2DM patients in both groups demonstrated a lower level of glycosylated hemoglobin after treatment,there were no statistical differences(P>0.05)between the two groups.Additionally,there were no significant differences(P>0.05)in the 2-hours postprandial blood glucose level between the two groups in this study.In contrast,the levels of fasting blood glucose and glycosylated serum protein of the T2DM patients in the acupuncture treatment group were significantly lower(P<0.05)than that of the control group.Patients with T2DM in both groups showed a significant decrease(P<0.01)in quantitative points of patient's TCM symptoms after their treatments.However,the TCM quantitative points in the acupuncture treatment group were significantly lower(P<0.05)when compared to that in the control group(without acupuncture treatment).A total of 89.66%effective rate was observed in T2DM patients when acupuncture therapy was performed in combination with the standard drug treatment for diabetes.Hence,the results obtained from this study indicated that the combination therapy method(using both acupuncture and the standard drug treatment)is more effective in improving the clinical symptoms of patients with T2DM than by administrating the standard drug treatments alone.In addition,the diversity and abundance of intestinal flora in both groups of T2DM patients decreased after the two weeks treatment period.The acupuncture treatment group exhibited a lower abundance of Firmicutes and a higher distribution of Bacteroidetes,thus resulting in an increased ratio of Bacteroidetes:Firmicutes(B:F)in the patients' gut.Furthermore,intestinal bacteria from the genus Escherichia,Enterococcus,Leuconostoc,Holdemania,Rothia,Prevotella,Roseburia,Campylobacter,Anaerotruncus,the species Peptostreptococcus anaerobius and Shuttleworthia satelles were reduced in abundance,whereas the affluence of Bifidobacterium and Clostridium in the gut of T2DM patients increased after acupuncture therapy.CONCLUSION:Acupuncture therapy was effective in regulating the levels of fasting blood glucose and glycosylated serum protein in patients with T2DM.This study also demonstrated that acupuncture treatment significantly improved the clinical symptoms of T2DM patients.Moreover,acupuncture therapy was shown to effectively restore the balance of the gut microbiota in patients with T2DM by:1.Reducing the diversity and abundance of intestinal microflora through the reduction of Gram-positive bacteria(i.e.Firmicutes,Enterococcus,Leuconostoc,Holdemani,Rothia,Clostridium,Roseburia,Peptostreptococcus anaerobius and Shuttleworthia satelles);2.Normalizing the affluence of gut microbiomes that are involved in lipid metabolism and delivering a higher B:F ratio in the gastrointestinal track by lowering the abundance of the phylum Firmicutes,Enterococcus and Roseburia,while increasing the abundance of Bacteroidetes and Bifidobacterium;3.Regulating the quantity of microflora that are involved in the formation of short-and medium-chain fatty acids by decreasing the plethora of Roseburia,Holdemania and Prevotella:4.Inhibiting inflammation through the promotion of Clostridium and Bifidobacterium while reducing the abundance of Prevotella bacteria;5.Preventing the growth of conditionally pathogenic bacteria and pathogenic bacteria that can cause infections(e.g.Escherichia,Enterococcus,Leuconostoc,Rothia,Prevotella,Campylobacter and Peptostreptococcus anaerobius).Based on the results obtained from this study,it is theorized that the gut microbiome disorders were closely related to the occurrence of type 2 diabetes.Acupuncture therapy can serve as a mechanism to regulate and improve T2DM symptoms in patients via the alteration of diversity and composition of the patients'gastrointestinal flora. |
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