AMERICAN RESEARCH THOUGHTS Volume 1 │ Issue 1 │ November 2014

ISSN: 2392 – 876X Available online at: www.researchthoughts.us

MAINTENANCE OF BLOOD SUGAR LEVEL

AMONG TYPE 2 DIABETES MELLITUS
PATIENTS BY USING AL-TENS OVER
ACUPOINT - A PILOT STUDY

Md. Asif Arsalan

Consultant Physiotherapist at K & K Pain & Rehabilitation Center, Saidpur, Bangladesh

Abstract: Background and objective: The incidence rate of type 2 diabetes is increasing day by day
at an alarming rate. Changing lifestyle and environment have contributory effect in increase rate of
type 2 diabetes mellitus. Hypothesis was that the AL-TENS (acupuncture like - TENS) on ST36 is a
complementary therapy for controlling plasma glucose in type 2 diabetes mellitus patients.
Methods: The study designed a single blind convenient clinical study of type 2 diabetes patients who
are already taking oral hypoglycemic pills to control blood glucose. In this study 30 patients were
selected on the basis of inclusion and exclusion criteria and divided into two equal groups; they were
assigned to receive either AL-TENS on the bilateral ST36 acupoints for 10 minutes for 7days or
placebo treatment 10 minutes for 7 days.
Result: There was significant improvement (P>0.05) in random blood sugar level of type 2 diabetes
mellitus.
Conclusion: It has been found AL- TENS on bilateral ST36 acupoints have an effect to control
plasma glucose level for type 2 diabetic mellitus patients and can be used without having any side
effect.

Key words: Type 2 diabetic mellitus, AL-TENS, Acupoint, plasma glucose level.

I. INTRODUCTION

The incidence of diabetic raising all over the world in an alarming rate, according to the
world health organization , diabetes mellitus affects at least 171 million people and
(1)

causes 3.2 million deaths, and 8700 deaths every day. A calculation of WHO shows
approximately 70% and 42% of cases of diabetes raises respectively in developed and

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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

developing countries in 2030. This may causes to affect 366 million people by 2030 .
(1)

According to an estimate Bangladesh which had a population of 149.8 million in 2011 (2)
showed immense prevalence of diabetes that was 9% in 2006 to 2010(3), which will
further increase to 13% by 2030.(4)
In developing countries, the majority diabetes patient’s age are 35-64 years,
whereas people in developed countries suffer more above 64 years of ages. (5). Diabetics
affects both health status and the economic status of the country. The overall health care
costs of diabetes mellitus ranges from 2.5% to 15% of annual health care budgets of
developed and developing countries(6). The increasing rate of diabetes has put a burden
on the country as well as on the individual who have been suffering from diabetes.
There are several risk factors of type 2 diabetes including ageing, gender, country
and place of residence, society, socioeconomic status, lifestyle and obesity (7)
.The type 2
diabetes have some devastating complication that can lead to death due to
cardiocascular problem, renal failure etc(8). some vascular problem such as –
arthrosclerosis, retinopathy, nephropathy, foot complications, skin complications,
hearing loss, gastroparesis, ketoacidosis (DKA), neuropathy, nephropathy, peripheral
arterial disease , stroke can be happen for long suffering of diabetes(9)
There are some treatment available that includes both modern and ancient
treatment protocol and both chemical and organic remedy to control blood sugar level
and to prevent complication from the constant high blood sugar. There are several types
of oral pills and injectable insulin available that inhibit the release of glucose from the
liver, improve the cells sensitivity to insulin, slow the breakdown of starches and sugars
to glucose (10). Alternative treatment; medicinal herbs, nutritional supplements and hot
tub therapy has become popular from last several years, to treat diabetes. (11)
Acupuncture a traditional Chinese treatment now a days is going to be famous in
some countries to treat diabetes, Acupuncture is effective in both to treat diabetes and
preventing complications of diabetes.(12) The effects of acupuncture on diabetes have
been observed experimentally and clinically.(13) The above treatments are having some
certain side effect and are not so cost effective that all the patient who suffering from
diabetes can afford these.
So it’s necessary to introduce some cost effective and less side effect treatment for
the rapidly growing diabetes. In this study AL-TENS (acupuncture like TENS) which
have high frequency had been use to over bilateral ST36 acupoint to control the blood
glucose level in the people of Bangladesh. This is the very first time using of

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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

electrotherapy modality in the field of physiotherapy in Bangladesh to control the blood

glucose level in type 2 diabetic patients. With local application of AL-TENS on
acupoint in control of blood sugar level have to help people to less depend on medicine
and at the same time it added a feather to caps of physiotherapists to manage medical
condition like diabetes.

II. MATERIAL AND METHODOLOGY

A number of 30 subjects were selected by convenient sampling method, including both

male and female between 35- 60 years old who were suffering from type 2 diabetes
since 1 - 10 years and taking only oral pills were included in this study. Subjects were
informed about the procedure and were signed an inform consent form before to enroll
in this study. Subjects with cardiac, neurological, gastrointestinal, gynecological, skin
disease, sensory impairment over the ST36 acupoint, psychiatric disorder were not in
including criteria for this study. The subjects who participated at this study were taking
medicine to control their blood sugar level but fail to control their sugar level in desire
level as they were also suffering with pain at their lower limb so that they were facing
difficulty to walk, as they were instructed to walk for control diabetes. Subjects were
ask to take their prescribed medicine as per there physicians instruction. They were also
asked to follow their normal daily routine as they were following. Selected subjects
were divided into two equal groups containing 15 subjects in each group. Group A
taken AL-TENS at frequency of 20 Hz and group B taken placebo stimulation of 0 Hz
over bilateral ST36 acupoint, with a common duration of 10 minutes for 7 days.
Random blood sugar was checked before and just after the stimulation by gluco meter
for both of the groups; stimulation was given after 2 hours of food on every day
regularly on stipulated time.

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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

30 type 2 diabetic patients

Group A Group B
(n = 15) (n= 15)

Stimulate with Stimulate with

AL-TENS Placebo stimulation

Frequency 20 Hz
Frequency 0 Hz
Duration 10 minuets
Duration 10 minuets
7 days
7 days

RBS checked before and RBS checked before and

just after the stimulation just after the stimulation

Figure 1: Flow chart of methodology

III. RESULTS

The result was analyzed by using spss 16.0 version, pair and independent ‘t’ test was
use to analysis the result and the significant level was set at P > 0.05. There was no
significant difference of age between group A and group B (47.8+7.63 vs 49.93 + 6.71
years) [table;1, figure;2], baseline level of RBS (235.0 + 104.4 vs 220.67 + 70.04 mm/dl ),
and the duration of disease (4.28 + 1.88vs 5.36 + 2.20 years) [Table;2, Figure;3]. The
random blood sugar which was checked before and just after the stimulation shows the
significant difference in group A from day 1 pre to day 7 post of stimulation (235.0 +
104.4 vs 149.1 + 56.1 ) [table;3, figure;4] and not such statistical significant difference in
group B from day 1 pre to day 7 post of stimulation ( 220.6 + 77.04vs 245.8 + 51.39 )
[Table:4, Figure:5]
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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

SN Parameter Group A Group B ‘t’ ‘P’

value value
mean SD SE mean SD SE
1 Age 47.80 7.63 1.97 49.93 6.71 1.73 0.359 0.554
NS

Table 1: Shows Comparison of mean and SD of age between the group A and group B.

Figure 2: Shows Comparison of mean and SD of age between the group A and group B.

SN Parameter Group A Group B ‘t’ ‘P’

value value
mean SD SE mean SD SE
1 Duration 4.28 1.88 0.38 5.36 2.20 0.44 1.866 0.0680
NS
2 RBS 235.0 104.4 26.95 220.67 77.04 19.89 .428 0.97
NS

Table 2: Comparison of mean, SD & SE in duration and level of RBS (base line) value between the
group A and group B.

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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

Figure 3: Comparison of mean in duration and level of RBS (base line) value between the group A
and group B.

SN Parameter Day 1 pre Day 7 post ‘t’ ‘P’

value value
RBS mean SD SE mean SD SE
5.11 0.000
1 Group A 235.0 104.4 26.9 149.1 56.1 14.6
S

Table 3: Shows comparison of mean, SD & SE in day1 pre and day 7 post RBS level in the group A.

Figure 4: Shows comparison of mean &SD in day1 pre and day 7 post RBS level in the group A.

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Asif Arsalan- MAINTENANCE OF BLOOD SUGAR LEVEL AMONG TYPE 2 DIABETES MELLITUS PATIENTS
BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

SN Parameter Day 1 pre Day 7 post ‘t’ ‘P’

value value
RBS mean SD SE mean SD SE
-1.26 0.227
1 Group B 220.6 77.04 19.89 245.8 51.39 13.27

Table 4: Shows comparison of mean, SD & SE in day1 pre and day 7 post RBS level in the group B.

Figure 5: Shows comparison of mean &SD in day1 pre and day 7 post RBS level in the group B.

IV. DISCUSSION

Treating diabetes with AL-TENS on bi lateral ST36 accupoint is effective in reducing

blood glucose level, especially those who are taking oral pill. In this study, TENS over
the ST36 acupoint can help to decrease plasma glucose concentrations in type 2 diabetic
mellitus patients. From the preliminary experiments, AL-TENS stimulation was found
to be effective over acupoint. A similar stimulation at the non-acupoint location didn’t
show any reduction of blood glucose level in type 2 diabetic. Acupuncturists found
about 20 acupoints that are effective in reducing blood glucose level. Acupuncture may
be effective in treating, preventing and managing complications of the diabetese (14)
According to the theory of traditional Chinese medicine, acupuncture regulates
‘Chi’ that runs through all the meridians of the body. Recently, ST36 acupoint is
considered as a vital acupoint to control plasma glucose. (Chang SL et al; 2006) 15. In this
study only one acupoint (ST36) bilaterally were used for a period of 10 minutes.

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BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

Whereas other studies used more points and they had also taken longer duration of
stimulation. This duration and the acupoint is suitable for patients as well as for
Physiotherapist and it is very first time, that electrotherapy modalities used in the field
of physiotherapy to reduce blood glucose Bangladesh so far.
Manual needling, and electro-acupuncture, is the most commonly used modality
today (G. A. Ulett, et al; 1998)16. In this study electrotherapy modality is used to apply
electrical stimulation on acupoint via skin electrodes. This was noninvasive and easy
method to use. Previous study which stimulate the ST36 and SP6 bilaterally on the non-
diabetic patient shows the transcutaneous electrical nerve stimulation on that point
improve the insulin resistance during the general anesthesia (Kee-Ming Man et al;
2010)17. As the animal and the non-diabetic patients experiment has shown different
mechanisms but both are related to decrease the blood glucose level. As this was the
very first study done on type2 diabetic patient, so actually what mechanism were
happening in the type 2 diabetic body is still unknown.
The beta cells of the pancreas are responsible for the secretion of insulin, the
hormone that facilitates the transport of energy-producing glucose into the body's cells.
In type 2 diabetes, dysfunction of these insulin-producing cells combined with a
decrease in the insulin response of individual cells, results in increased blood sugar
levels. The progression of beta-cell dysfunction associated with increased insulin
resistance is the usual indication for the use of oral anti-diabetic medications. With
effective oral anti-diabetic medication, hyperglycemia or high blood sugar levels can be
corrected. Generally people who suffering from type 2 diabetics takes various type of
medicines by the advice of physicians to control their blood glucose level. The
medicines that commonly use in diabetic mellitus have property of insulin
secretagogues and Insulin sensitizers.
The insulin secretagogues are a group of oral medications that stimulate the beta
cells of the pancreas to secrete more insulin. They also decrease glucose production by
the liver and enhance the burning of glucose into usable energy forms by individual
muscle fibers. (Alvin 2008)18. Insulin sensitizers are a group of oral medications that
enhance the action of the insulin in the body.
From the previous study which had done on the animals and non-diabetic
patients with the electeopuncture and transcutaneous electrical nerve stimulator have
shown the similar effect of medicine that it helps to improves the insulin resistance, to

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BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

enhance insulin synthesis, to increase the number of receptors on target cells, and to
accelerate the utilization of glucose.(12)
The TENS (transcutaneous electrical nerve stimulation) is very common and
available modality which is used in physiotherapy department. This was cost effective
and less time consuming procedure in the blood glucose reduction. During the
treatment subjects who have mild to moderate pain at their leg also reporting less or no
pain at their leg after completion of the treatment. Commonly people who suffering
from diabetics takes medicine or insulin to control the blood glucose level which have
some side effect after long time using, but the TENS have no such type of side effect on
human body. This new approach of reduction blood glucose level gives a new
treatment procedure and opens a new use of TENS rather than to traditional use in pain
management and also which is free from any side-effect to the diabetic patient. So
transcutaneous electrical nerve stimulation can be used as a safe and new method to
control the blood glucose level for whom suffering from type 2 diabetes mellitus.

V. LIMITATION AND FUTURE SCOPE

The sampling was selected in convenient method; this could be a random method for
the future study, as well as the sample size can be increase as this was a small sample
size. The parameter used in this study was only random blood sugar in future study
there can be more parameter use in future. Some other type diabetes patients can be
included in future to see the effect of TENS on the other type of diabetes.

VI. CONCLUSION

In this study we have been found that application of AL-TENS is effective in

maintaining blood glucose level among the patient of type 2 diabetes those who had
difficulty in walking due to lower limb pain. Hence we conclude that AL-TENS along
with medicine have a significant effect on blood glucose level among type 2 diabetic
mellitus.

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BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

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BY USING AL-TENS OVER ACUPOINT - A PILOT STUDY

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