Should Prediabetes be Treated Pharmacologically?

Efficacy and optimal acupoints of auricular acupressure for treating prediabetes: a meta-analysis and data mining

BACKGROUND AND PURPOSE

Auricular acupressure has potential in treating prediabetes; however, its effectiveness remains unclear. We aimed to evaluate the effect of auricular acupressure on blood glucose levels in patients with prediabetes and to identify optimal acupoints.

METHODS

We searched nine public databases for randomized controlled trials published before March 1, 2025, according to pre-established inclusion and exclusion criteria. The risk of bias was assessed using the Risk of Bias 2 tool. RevMan 5.3 was employed to conduct a meta-analysis on glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), and 2-h postprandial blood glucose (2h-PBG) levels, and body mass index (BMI). We used a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Data mining was used to determine optimal acupoints.

RESULTS

This meta-analysis involved eight studies (694 participants). Compared with lifestyle intervention alone, auricular acupressure combined with lifestyle intervention significantly reduced HbA1c (mean difference [MD] -0.51, 95 % CI -0.84 to -0.18), FBG (MD -0.63, 95 % CI -0.94 to -0.31), and 2h-PBG (MD -0.78, 95 % CI -0.95 to -0.62) levels in patients with prediabetes but no significant effect was observed concerning BMI (MD -0.26, 95 % CI -1.15 to 0.63). The GRADE showed low to very low certainty levels of evidence. Data mining indicated that CO4, CO10, CO11, CO13, CO14, and CO17 were core acupoints for prediabetes.

CONCLUSION

Auricular acupressure demonstrates potential as a complementary approach for prediabetes, with CO4, CO10, CO11, CO13, CO14, and CO17 identified as optimal acupoints. However, due to methodological limitations, these findings require further validation through high-quality evidence.

Weight Reduction with GLP-1 Agonists and Paths for Discontinuation While Maintaining Weight Loss

Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.

Metabolic Alteration Bridging the Prediabetic State and Colorectal Cancer

Prediabetes and colorectal cancer (CRC) represent compelling health burdens responsible for high mortality and morbidity rates, sharing several modifiable risk factors. It has been hypothesized that metabolic abnormalities linking prediabetes and CRC are hyperglycemia, hyperinsulinemia, and adipokines imbalance. The chronic stimulation related to these metabolic signatures can favor CRC onset and development, as well as negatively influence CRC prognosis. To date, the growing burden of prediabetes and CRC has generated a global interest in defining their epidemiological and molecular relationships. Therefore, a deeper knowledge of the metabolic impairment determinants is compelling to identify the pathological mechanisms promoting the onset of prediabetes and CRC. In this scenario, this review aims to provide a comprehensive overview on the metabolic alterations of prediabetes and CRC as well as an overview of recent preventive and therapeutic approaches for both diseases, focusing on the role of the metabolic state as a pivotal contributor to consider for the development of future preventive and therapeutic strategies.

A study on the use of acupoint catgut embedding in the treatment of pre-diabetes: a meta-analysis and data mining approach

Objective

The efficacy of acupoint catgut embedding (ACE) for the treatment of pre-diabetes remains controversial. Therefore, this study investigated the clinical efficacy and acupoint selection in ACE for the treatment of pre-diabetes.

Methods

Eight common databases were searched for relevant literature on ACE for pre-diabetes. Meta-analysis was used to evaluate its efficacy and safety, and data mining was used to explore the protocol for acupoint selection.

Results

The meta-analysis revealed that compared with conventional treatment alone, conventional treatment combined with ACE reduced the levels of glycated hemoglobin A1c [mean difference (MD) -0.45, 95% confidence interval (CI) -0.67 to -0.24%, p < 0.001], fasting blood glucose (MD -0.61 mmol/L, 95% CI -0.87 to -0.36 mmol/L, p < 0.001), 2-h postprandial glucose (MD -0.77 mmol/L, 95% CI -0.98 to -0.55 mmol/L, p < 0.001), total cholesterol (MD -0.37 mmol/L, 95% CI -0.74 to 0.00 mmol/L, p = 0.049), triglyceride (MD -0.49 mmol/L, 95% CI -0.77 to -0.20 mmol/L, p < 0.001) and low-density lipoprotein cholesterol (MD -0.23 mmol/L, 95% CI -0.33 to -0.12 mmol/L, p < 0.001), and increased high-density lipoprotein cholesterol levels (MD 0.16 mmol/L, 95% CI 0.05 to 0.27 mmol/L, p = 0.004), whereas changes in the body mass index and the adverse event rates were comparable between groups. Data mining revealed that Pishu (BL20), Weiwanxiashu (EX-B3), Zusanli (ST36), Shenshu (BL23), Sanyinjiao (SP6), Weishu (BL21), and Taixi (KI3) were the core acupoints used in ACE for pre-diabetes.

Conclusion

ACE can effectively improve blood glucose and lipid levels in pre-diabetes patients and has a good safety profile. ACE consisting of Pishu (BL20), Weiwanxiashu (EX-B3), Zusanli (ST36), Shenshu (BL23), Sanyinjiao (SP6), Weishu (BL21), and Taixi (KI3), is a promising complementary strategy for the treatment of pre-diabetes.