An integrative approach to health also includes a number of modalities collectively known as manual medicine: acupuncture, massage/energy therapy, acupressure, and chiropractic and other forms of manipulation. Evidence on these modalities for the treatment of diabetes and diabetic complications is limited.
Acupuncture. Although acupuncture has long been reported to improve glycemic control in patients with diabetes and prediabetes, the evidence is limited and of poor quality.36,37
In recent years, 2 small RCTs have found that acupuncture reduced pain in patients with diabetic peripheral neuropathy vs sham acupuncture or oral inositol.38,39 In one of the studies, 87.5% of participants randomized to acupuncture had symptom improvement, compared with 63.6% of those in the oral inositol group. In fact, marked symptom relief after 3 months of treatment was reported by 50% of those Acupuncture reduced pain in patients with diabetic peripheral neuropathy vs sham acupuncture or oral inositol. who had acupuncture, compared with 21% of those who did not.39
In a small 2-week RCT, patients randomized to acupuncture vs sham acupuncture for diabetic bladder dysfunction showed statistically significant improvements in both subjective symptoms and urodynamic measurements.40 And a study comparing patients receiving electroacupuncture—in which an electric current is transmitted between 2 needles placed in the muscles—vs sham acupuncture found nonstatistically significant improvements in symptomatic gastroparesis.41
Massage/energy therapy. Massage has been shown in several studies to reduce glucose levels,42-44 although no reductions in glucose levels were found in one small RCT.45 Connective tissue reflex massage led to improved lower limb blood flow in patients with diabetes and peripheral artery disease in another study, but the clinical significance is uncertain.46 Studies of reflexology and acupressure are similarly limited to small experimental and observational studies.47 No RCTs of chiropractic treatment for diabetes were found.
CORRESPONDENCE Jacqueline Redmer, MD, MPH, Department of Family Medicine, University of Wisconsin, 1100 Delaplaine Court, Madison, WI 53715; jackie.redmer@fammed.wisc.edu
ACKNOWLEDGEMENTS The authors thank Drs. Sarina Schrager and Mindy Smith for their manuscript assistance. The work presented here was carried out while Drs. Longmier and Wedel were Primary Care Research Fellows supported by a National Research Service Award (T32HP10010) from the Health Resources and Services Administration to the University of Wisconsin Department of Family Medicine.
