Stimulated by Milia et al 2026.[1]
T2DM – type 2 diabetes mellitus
EA – electroacupuncture
PCOS – polycystic ovarian syndrome
PMOS – polyendocrine metabolic ovarian syndrome
IF – impact factor
RCT – randomised controlled trial
MA – manual acupuncture– key to acronyms
I first heard about the possibility of EA influencing insulin sensitivity in the late 00s from Lisa S-V (Elisabet Stener-Victorin).[2] She was well into her research career focussing on PCOS (now renamed as PMOS, [3–5] which is quite relevant here), and had started to look at the metabolic effects of EA.[2,6–13]
Interestingly, this paper does not reference any of this early mechanistic work. The paper is published as an open access research letter in the journal Diabetes, Obesity and Metabolism (IF 6.1), and the team are based in Florence, Italy.
From my earliest experience of acupuncture, I remember senior colleagues mentioning that insulin requirements may drop after acupuncture treatment in diabetic patients, but this is the first time I have seen hard evidence.
It is a pilot crossover RCT of MA versus a superficial penetrating off point sham in overweight patients with T2DM whose treatment included insulin therapy for at least 6 months and whose HBA1c was <69 mmol/mol.
It was intended to include 42 patients, but due to the COVID 19 pandemic and the introduction of new treatments in T2DM, enrolment was stopped after the first 23 patients. Only 15 patients completed both phases of the trial.
The acupuncture treatment was performed twice a week for 12 weeks. Each session involved treatment supine and prone for 20 minutes each. The real MA involved needling with de qi at SP6, ST36, KI3, CV4, CV12, ST28, LI4, LI11, TE5, Yintang, BL23. BL22, BL20, and BL13.
The sham MA involved superficial insertion of 3 needles in each of three sites in the limbs that were between meridians and in different dermatomes from the points used in the real MA group. The sites were the upper outer arm, the posterolateral thigh, and the posterolateral calf. The 3 needles were placed in an equilateral triangle at 1cm from eachother.
All the details are in a supplement that partly reads like a protocol with portions updated with what actually happened. In places there is some inconsistency, so despite there being rather excessive detail, the reader is still left unsure of being able to fully reproduce the treatment.
The washout period was 1 month and was followed by a further 12 weeks of the other treatment. 8 patients started with real MA and 7 with sham.
The primary outcome was the reduction in daily insulin dose. The insulin dose was adjusted by a diabetologist who was blind to group allocation. Adjustments were made according to a pre-specified protocol and based on patient-reported glucose self-monitoring.
In the first phase of the trial, the real MA group had a roughly 20% reduction in insulin requirements with nothing much happening in the sham group. During the washout period the real MA group increased insulin requirements by just under 10% and curiously, the sham group reduced their requirements to a similar degree. The two groups stayed roughly similar throughout the second phase of the trial.
When both phases of the trial were considered, real MA was associated with a 13% reduction in insulin requirement compared with the sham MA. This was a significant different despite the rather small numbers.
This is a small and under-powered trial with an inadequate washout period; however, it is the first of its kind, and that is the main reason I have highlighted it here. We clearly have to be cautious in concluding that acupuncture does influence insulin requirements from this trial alone, but when you add the plausibility from basic science research together with the clinical experience of experienced acupuncturists, it looks a little more convincing.
References
1 Milia A, Silverii GA, Cortoni L, et al. Acupuncture May Reduce Insulin Doses in Overweight Insulin-Treated Patients With Type 2 Diabetes Mellitus: A Crossover Randomized Controlled Pilot Trial. Diabetes Obes Metab. Published Online First: 3 June 2026. doi: 10.1111/dom.70941
2 Johansson J, Feng Y, Shao R, et al. Intense electroacupuncture normalizes insulin sensitivity, increases muscle GLUT4 content, and improves lipid profile in a rat model of polycystic ovary syndrome. Am J Physiol-Endocrinol Metab. 2010;299:E551–9. doi: 10.1152/ajpendo.00323.2010
3 Stener-Victorin E, Carlsson S, Hagström H, et al. MASLD, diabetes and PMOS across the female life stages. Diabetologia. Published Online First: 5 June 2026. doi: 10.1007/s00125-026-06761-y
4 Teede HJ, Vanky E, Piltonen TT, et al. Polyendocrine metabolic ovarian syndrome in pregnancy: pathophysiology and outcomes. Nat Rev Endocrinol. Published Online First: 5 June 2026. doi: 10.1038/s41574-026-01261-w
5 Teede HJ, Khomami MB, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407:2329–39. doi: 10.1016/S0140-6736(26)00717-8
6 Stener-Victorin E, Baghaei F, Holm G, et al. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Fertil Steril. 2012;97:501–8. doi: 10.1016/j.fertnstert.2011.11.010
7 Johansson J, Manner\aas-Holm L, Shao R, et al. Electrical vs Manual Acupuncture Stimulation in a Rat Model of Polycystic Ovary Syndrome: Different Effects on Muscle and Fat Tissue Insulin Signaling. PLoS ONE. 2013;8:e54357. doi: 10.1371/journal.pone.0054357
8 Benrick A, Maliqueo M, Johansson J, et al. Enhanced insulin sensitivity and acute regulation of metabolic genes and signaling pathways after a single electrical or manual acupuncture session in female insulin-resistant rats. Acta Diabetol. 2014;51:963–72. doi: 10.1007/s00592-014-0645-4
9 Stener-Victorin E, Maliqueo M, Soligo M, et al. Changes in HbA 1c and circulating and adipose tissue androgen levels in overweight-obese women with polycystic ovary syndrome in response to electroacupuncture. Obes Sci Pract. 2016;2:426–35. doi: 10.1002/osp4.78
10 Kokosar M, Benrick A, Perfilyev A, et al. A Single Bout of Electroacupuncture Remodels Epigenetic and Transcriptional Changes in Adipose Tissue in Polycystic Ovary Syndrome. Sci Rep. 2018;8:1878. doi: 10.1038/s41598-017-17919-5
11 Benrick A, Pillon NJ, Nilsson E, et al. Electroacupuncture Mimics Exercise-Induced Changes in Skeletal Muscle Gene Expression in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2020;105:1–15. doi: 10.1210/clinem/dgaa165
12 Li J, Wu W, Stener-Victorin E, et al. A prospective pilot study of the effect of acupuncture on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance. Acupunct Med. 2020;38:310–8. doi: 10.1177/0964528420902144
13 Wen Q, Hu M, Lai M, et al. Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial. Hum Reprod. 2022;37:542–52. doi: 10.1093/humrep/deab272
The BMAS Blog 
You must be logged in to post a comment.