ReviewInternational journal of general medicine2026
Acupuncture and Moxibustion for Prediabetes: Pathophysiological Rationale, Clinical Evidence, and Research Gaps.
Review in International journal of general medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Prediabetes, an intermediate metabolic state between normoglycemia and type 2 diabetes mellitus, has emerged as a silent global epidemic with a rising prevalence and substantial cardiometabolic risks. Despite the established diagnostic criteria from major health organizations, significant controversies persist regarding optimal screening definitions, inter-ethnic variability, and low concordance among fasting glucose, HbA1c, and postprandial glucose assessments. Pathophysiologically, prediabetes involves a dynamic interplay between tissue-specific insulin resistance (hepatic in impaired fasting glucose and skeletal muscle in impaired glucose tolerance), β-cell dysfunction, and multi-organ crosstalk, underpinned by chronic low-grade inflammation, mitochondrial dysregulation, and lipotoxicity. Within this complex landscape, acupuncture and moxibustion, rooted in traditional Chinese medicine yet increasingly validated by modern mechanistic studies, offer a multimodal therapeutic strategy. Emerging evidence from randomized controlled trials and meta-analyses has demonstrated that acupuncture-related therapies significantly reduce fasting blood glucose, postprandial glucose, and HbA1c levels, while improving insulin resistance, modulating the leptin signaling pathway, and restoring β-cell homeostasis via neuroendocrine regulation (eg, vago-islet axis, hypothalamic-pituitary-adrenal axis). Innovative protocols, including electroacupuncture, Zhuang medicine scraping combined with blood-letting, and auricular acupoint embedding have shown promising clinical efficacy and favorable safety profiles. Nevertheless, methodological heterogeneity, small sample sizes, and limited long-term follow-up remain challenges. This manuscript critically synthesizes the contemporary understanding of prediabetes, from diagnostic controversies and global epidemiology to integrated pathophysiology, and positions acupuncture and moxibustion as a scientifically grounded, low-risk, and scalable intervention. Future studies should prioritize large-scale multicenter trials, multi-omics mechanistic dissection, and standardized clinical protocols to fully harness the therapeutic potential of acupuncture in curbing the diabetes pandemic.
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