| ObjectivePrediabetes is the key period for the transformation to diabetes,and active intervention is particularly important.This study explored the etiology and pathogenesis of prediabetes through modern literature research,and provided the idea of syndrome differentiation for clinical diagnosis and treatment of prediabetes.Through clinical study,the effect of auricular electrotherapy on blood glucose level and HbAlc concentration in patients with prediabetes was systematically observed,and its safety was evaluated,in order to provide an effective treatment plan for clinical auricular acupuncture in the treatment of prediabetes.Methods1 Literature researchStudyI:Research clinical literature on the syndromes of prediabetes in the past 10 years on CNKI,and the TCM syndromes of prediabetes were counted by searching with the subj ects of "prediabetes" or "abnormal glucose regulation" or"impaired fasting glucose" or "abnormal glucose tolerance" and "syndrome" or "syndrome type" or "syndrome differentiation" or"symptom".To analyze the syndrome and syndrome elements of prediabetesStudyII:By searching the recent 10 years' clinical research literature on acupuncture and moxibustion in the treatment of prediabetes on CNKI,The subjects of "pre-diabetes" or"abnormal glucose regulation" or"impaired fasting glucose" or"abnormal glucose tolerance"and "acupuncture" or"moxibustion" or "electroacupuncture" or "ear acupuncture" or "acupoint injection" or "acupoint embedding" or "abdominal acupuncture" were searched,and statistics were made on acupuncture treatment of acupoints in prediabetes and the methods of acupuncture and moxibustion.To analyze the law of acupoint selection and the application of acupuncture and moxibustion.2 Clinical researchRandomized,controlled trials were used to generate a randomized scheme by computer.Forty-seven patients with prediabetes who were admitted to the Spleen and Department and Encephalopathy Department of the Acupuncture and Moxibustion Hospital of China Academy of Chinese Medical Sciences from April 2019 to December 2020 were included.The basic data of the enrolled patients were recorded,and the TCM clinical symptoms and signs of 47 patients with prediabetes were observed.Then according to the scheme of random all of the patients were randomly divided into taVNS and tnVNS,use of hua tuo card electronic needle therapy instrument(model model SDZ-?B,suzhou medical supplies factory co.,LTD.,production)treatment,taVNS groups ear nails area "spleen-pancreatic biliary" stimulation,tnVNS group for ear margin area.The output current of the instrument is 1mA,the pulse frequency is 20Hz,the pulse width is no more than 1 ms,the intensity was measured to the extent that the subject could tolerate it without causing pain.The stimulation time was 30 minutes each time,twice a day,and the treatment began half an hour after lunch and dinner.6 weeks as a course of treatment,divided into 2 courses,a total of 12 weeks of treatment.Record the patients before treatment and 6 weeks and 12 weeks of treatment before a meal blood glucose(FPG),Postprandial blood glucose(OGTT2hPG)and glycosylated hemoglobin(HbA1c),after the test summary data,using sas8.1 statistical analysis,finally,the clinical effect of electroacupuncture of ear concha in the treatment of prediabetes determined and the safety of this therapy was evaluated.Results1 Literature studyStudy?:A total of 16 literatures were included,and the total number of reported cases was 2219.After integration,there were 16 syndrome,including 618 cases of spleen deficiency with phlegm and dampness(27.85%),267 cases of Qi and Yin deficiency type(12.03%),238 cases of dampness-heat accumulation 10.73%),197 cases of Yin deficiency(8.88%),etc.12 syndrome elements of pre-diabetes were extracted,4 disease location elements were spleen,liver,stomach and kidney,and 8 disease elements were dampness,phlegm,yin deficiency,qi deficiency,qi stagnation,heat,blood stasis and Yang deficiency,respectively.Study?:Participants included 61 references,the effective prescription of 70 article,involves the 70 acupuncture points,including 49 acupuncture points,20 auricular points,1 the extraordinary points,the top 5 most frequently used point were Zusanli,Pishu,Sanyinjiao,Shenshu and Yishu,the top 5 auricular points were endocrine,pancreas,sanjiao,stomach and spleen,top 5 in the use frequency of acupuncture and moxibustion were traditional needle acupuncture,ear acupuncture,acupoint catgut embedding,electric acupuncture and acupoint injection.2 Clinical research47 patients were included in the study,of which 4 fell off,and a total of 43 completed the study.Baseline:There was no statistical significance in demographic data,primary and secondary indexes between the two groups(P>0.05),indicating good comparability between the two groups.Syndrome:The symptoms and frequency of 47 patients with prediabetes were thirst(57.45%).tiredness and weakness(48.94%),blurred vision(46.81%),insomnia(36.17%).shortness of breath and lazy speech(29.79%),hyperphagia(25.53%),abdominal distention(21.28%).drowsiness of head and body(21.28%),constipation(12.77%),dysphoria with feverish sensation in chest?palms and soles(12.77%).The syndrome included spleen deficiency with phlegm and dampness(20 cases),dampness-heat accumulation(13 cases),qi stagnation and blood stasis(5 cases),and qi and Yin deficiency(5 cases).Main indicators:(1)FPG:The decreasing frequency of taVNS was higher than that of tnVNS(P<0.05).Compared with before treatment,there was no significant difference in the taVNS at 6 and 12 weeks of treatment(P>0.05),and there was no significant difference in the tnVNS(P>0.05).Compared with the treatment for 6 weeks,FPG in the taVNS decreased after 12 weeks(P<0.05),while there was no significant difference in the tnVNS(P>0.05).There was no significant difference in FPG between the two groups after 6 and 12 weeks of treatment(P>0.05).(2)2hPG:the number of 2hPG decrease cases in the taVNS after 12 weeks of treatment was significantly better than that in the tnVNS(P<0.001).Compared with before treatment,2hPG in the taVNS decreased at 6 weeks and 12 weeks after treatment,the difference was statistically significant(P<0.05).2hPG in the tnVNS decreased at 6 weeks after treatment,the difference was statistically significant(P<0.05).but there was no statistically significant difference in 2hPG at 12 weeks after treatment(P>0.05).There was no significant difference in 2hPG between the two groups after 6 weeks of treatment(P>0.05).2hPG in the taVNS was lower than that in the tnVNS after 12 weeks of treatment(P<0.05).(3)HbA1c:The decreasing frequency of taVNS was higher than that of tnVNS(P<0.005)after 12 weeks of treatment.Compared with before treatment,the HbAlc in the taVNS decreased after 12 weeks of treatment,and the difference was statistically significant(P<0.05).There was no significant difference in HbAlc in the tnVNS after 12 weeks of treatment(P>0.05).There was no significant difference in HbAlc between the two groups after 12 weeks of treatment(P>0.05).(4)The total effective rate:in taVNS,after 12 weeks of treatment,8 cases were significantly effective,8 cases were effective,6 cases were ineffective,and the total effective rate was 72.72%.In tnVNS,after 12 weeks of treatment,3 cases were significantly effective,8 cases were effective,10 cases were ineffective,and the total effective rate was 52.38%.The total effective rate of the taVNS was higher than that of the tnVNS.Secondary indicators:(1)BMI:there was no significant difference in the frequency of decline between the two groups after 12 weeks of treatment(P>0.05);Compared with before treatment,the BMI of the taVNS decreased after 12 weeks of treatment,the difference was statistically significant(P<0.05).while there was no significant difference in the tnVNS after treatment(P>0.05).There was no significant difference in BMI between the two groups after 12 weeks of treatment(P>0.05).(2)TCM symptom score:Compared with before treatment,the score of taVNS decreased after 12 weeks of treatment,the difference was statistically significant(P<0.05).while there was no statistically significant difference after 12 weeks of treatment in the tnVNS(P>0.05).There was no significant difference in scores between the two groups after 12 weeks of treatment(P>0.05).Safety analysis:There was no significant difference in the basic vital indexes between two groups before and after treatment(P>0.05).Two patients showed slight swelling and pain in their ears during the treatment process,so they were asked to reduce the amount of ear acupuncture stimulation,and the swelling and pain disappeared after 3 days.Therefore,it can be considered that ear acupuncture therapy is relatively safe in the clinical treatment of prediabetes.ConclusionLiterature research results show that the most common syndrome of prediabetes is spleen deficiency and phlegm-dampness syndrome,and the disease location is mainly in the spleen.The disease syndrome is mainly dampness and phlegm-dampness syndrome.The common type in this clinical study is also spleen deficiency and phlegm-dampness syndrome,which confirms the literature research results.Acupuncture and moxibustion treatment of body points mainly include Zusanli,Pishu,Sanyinjiao,Shenyu and Yishu,ear points mainly include endocrine,pancreas,Sanjiao,stomach and spleen,body points and ear points are related to the viscera,mainly to regulate the spleen and stomach.In the clinical research,taVNS can effectively improve FPG,2hPG,HbA1c and BMI ofpatients with prediabetes,and alleviate clinical symptoms,with the most significant effect on 2hPG.In addition,tnVNS can also improve the 2hPG and other indicators of prediabetes,and alleviate the clinical symptoms,but the clinical effect is worse than that of the taVNS.Ear acupuncture therapy is a safe treatment method with unique advantages such as safety,effectiveness and portability.It is worthy of clinical promotion and application. |
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