Application of Acupuncture in Diabetic Vascular Complications: Efficacy and Potential Mechanisms.

Abstract

Diabetes and its complications are a major global public health issue. Conventional Western medicine has limitations in efficacy and safety in managing complications, while acupuncture, with multitarget regulation and low side effects, serves as an important supplementary therapy. This review discusses how acupuncture relieves macrovascular complications, such as angina and cerebral reperfusion, by inhibiting NF-κB, improving vascular endothelial function, and regulating autonomic nerves. In addition, acupuncture delays microvascular complications, such as retinopathy and proteinuria via vasodilation, anti-inflammatory effects, antioxidative effects, and neurotrophic promotion. Acupuncture also benefits other complications by enhancing microcirculation and neuroendocrine function. The mechanisms of acupuncture involve regulating the metabolic-inflammatory-neurovascular network, activating pathways (such as GLP-1 and SDF-1), and repairing cellular structures. Modern technologies-including artificial intelligence (AI) for individualized acupoint selection, functional magnetic resonance imaging (fMRI) for central regulation visualization, and biomaterial combination for diabetic foot repair-enhance the precision of acupuncture. However, clinical translation of acupuncture faces the following challenges: fragmented mechanisms; insufficient clinical evidence, including small samples, short follow-ups, and a lack of long-term safety data when used with new hypoglycemics; and technical nonstandardization, such as inconsistent acupoint selection, nonuniform operation parameters, and poor adaptability of AI to traditional Chinese medicine syndrome differentiation. Future research should deepen the exploration of the neuroendocrine-immune network via interdisciplinary integration, conducting large-sample long-term trials, establishing standardized protocols, and validating AI/fMRI-assisted precision acupoint selection to accelerate the transition of acupuncture from adjuvant to precision therapy to improve patients' quality of life.