Mechanisms of acupuncture in the treatment of type 2 diabetes mellitus: insights from the regulation of the gut microecology

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with a complex etiology, in which gut microecological dysregulation plays a central role in disease onset and progression. Acupuncture, a non-pharmacological intervention rooted in traditional Chinese medicine, confers multi-target and systemic regulatory effects, and has been extensively applied in the prevention and management of T2DM. This review systematically examines the roles of gut microbiota dysbiosis, aberrant gut-derived metabolites, intestinal barrier dysfunction, and chronic low-grade inflammation in the pathophysiology of T2DM. It further delineates the potential mechanisms by which acupuncture indirectly mitigates T2DM through modulation of the "gut microbiota-metabolite-intestinal barrier-inflammation" axis, alongside its direct actions on insulin signaling pathways and pancreatic β-cell function. Drawing on recent advances in multi-omics technologies, this review discusses the prospects and challenges of applying acupuncture in individualized and precision treatment of T2DM, aiming to provide a conceptual framework and theoretical foundation for an integrated diabetes prevention and treatment paradigm with distinctive features of traditional Chinese medicine.