Electroacupuncture in glycemic control: Transitioning from clinical controversies to potential basic research

Table 4 Classification of main mechanisms in electroacupuncture for hypoglycemic research

Specific mechanism	Supporting evidence	Relevant acupoints	Experimental subjects	Ref.
HPA axis regulation	Reduces adrenal corticosteroids (such as cortisol), improves endocrine disorders	Yishu (EX-B3)	T2DM rats	[3]
Anti-inflammatory pathway	Inhibits NLRP3 inflammasome activation, reduces IL-1β, improves chronic inflammation	Non-specific	STZ-induced diabetic rats, HFD high-fat diet mice, db/db genetically diabetic mice, OLETF obese diabetic rats	[12]
Neurobiological mechanism	Enhances parasympathetic nerve (e.g., vagus nerve) activity, improves local circulation and glucose consumption	Zhongwan (CV12), Tianshu (ST25), etc.	OLETF rats	[38]
Gut microbiota and inflammation control	Increases SCFAs, reduces circulating LPS levels, lowers systemic inflammation	Zhongwan (CV12), Tianshu (ST25), Zusanli (ST36)	T2DM model	[26]
Insulin signaling pathway activation	Activates PI3K/Akt pathway, enhances GLUT2 and GCK mRNA expression, reduces fasting insulin levels	Zusanli (ST36), Shenshu (BL23)	T2DM rats	[3]
ta-VNS	Stimulates auricular vagus nerve via projections from the vagus nerve (ABVN) to the NTS, affects the concentration changes of the neurotransmitters noradrenaline, GABA and ACh in the central nervous system	Non-specific	Humans, SD rats	[39,40]

LPS: Lipopolysaccharide; ACh: Acetylcholine; GABA: Γ-aminobutyric acid; NTS: Nucleus tractus solitaries; ta-VNS: Transcutaneous auricular vagus nerve stimulation; HPA: Hypothalamic-pituitary-adrenal; SCFA: Short-chain fatty acid; HFD: High-fat diet; STZ: Streptozotocin; IL: Interleukin; GLUT2: Glucose transporter 2; GCK: Glucokinase; NTS: Nucleus tractus solitaries; SD rats: Sprague-Dawley rats.