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Original Contribution| Volume 49, ISSUE 5, P1259-1267, May 2023

Ultrasound Stimulation Potentiates Management of Diabetic Hyperglycemia

  • Chia-Hsuan Chang
    Affiliations
    Graduate Degree Program of the College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan

    Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County, Taiwan
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  • Kang-Chih Fan
    Affiliations
    Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan

    Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
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  • Yuan-Pin Cheng
    Affiliations
    Electronic Systems Research Division, National Chung-Shan Institute of Technology, Taoyuan City, Taiwan
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  • Author Footnotes
    @ These authors contributed equally.
    Jung-Chih Chen
    Footnotes
    @ These authors contributed equally.
    Affiliations
    Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan

    Department of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan

    Catholic Mercy Hospital, Catholic Mercy Medical Foundation, Hsinchu County, Taiwan

    Medical Device Innovation & Translation Center, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
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  • Author Footnotes
    @ These authors contributed equally.
    Gin-Shin Chen
    Correspondence
    Corresponding author. No. 35, Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan, ROC.
    Footnotes
    @ These authors contributed equally.
    Affiliations
    Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli County, Taiwan

    Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
    Search for articles by this author
  • Author Footnotes
    @ These authors contributed equally.

      Objective

      Glucose homeostasis is the only way to manage diabetic progression as all medications used do not cure diabetes. This study was aimed at verifying the feasibility of lowering glucose with non-invasive ultrasonic stimulation.

      Methods

      The ultrasonic device was homemade and controlled via a mobile application on the smartphone. Diabetes was induced in Sprague–Dawley rats through high-fat diets followed by streptozotocin injection. The treated acupoint CV12 was at the middle of the xiphoid and umbilicus of the diabetic rats. Parameters of ultrasonic stimulation were an operating frequency of 1 MHz, pulse repetition frequency of 15 Hz, duty cycle of 10% and sonication time of 30 min for a single treatment.

      Discussion

      The diabetic rats exhibited a significant decrease of 11.5% ± 3.6% in blood glucose in 5 min of ultrasonic stimulation (p < 0.001). After the single treatment on the first day, third day and fifth day in the first week, the treated diabetic rats had a significantly small area under the curve of the glucose tolerance test (p < 0.05) compared with the untreated diabetic rats in the sixth week. Hematological analyses indicated that the serum concentrations of β-endorphin were significantly increased by 58% ± 71.9% (p < 0.05) and the insulin level was increased by 56% ± 88.2% (p = 0.15) without statistical significance after a single treatment.

      Conclusion

      Therefore, non-invasive ultrasound stimulation at an appropriate dose can produce a hypoglycemic effect and improve glucose tolerance for glucose homeostasis and may play a role as adjuvant therapy with diabetic medications in the future.

      Keywords

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      References

        • Cole JB
        • Florez JC.
        Genetics of diabetes mellitus and diabetes complications.
        Nat Rev Nephrol. 2020; 16: 377-390
        • Maahs DM
        • West NA
        • Lawrence JM
        • Mayer-Davis EJ
        Epidemiology of type 1 diabetes.
        Endocrinol Metab Clin North Am. 2010; 39: 481-497
        • Kahn SE
        • Hull RL
        • Utzschneider KM.
        Mechanisms linking obesity to insulin resistance and type 2 diabetes.
        Nature. 2006; 444: 840-846
        • Yang Q
        • Vijayakumar A
        • Kahn BB.
        Metabolites as regulators of insulin sensitivity and metabolism.
        Nat Rev Mol Cell Biol. 2018; 19: 654-672
        • Ferrannini E
        • DeFronzo RA.
        Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes.
        Eur Heart J. 2015; 36: 2288-2296
        • Goodarzi MO
        • Bryer-Ash M.
        Metformin revisited: re-evaluation of its properties and role in the pharmacopoeia of modern antidiabetic agents.
        Diabetes Obes Metab. 2005; 7: 654-665
        • Horita S
        • Nakamura M
        • Satoh N
        • Suzuki M
        • Seki G.
        Thiazolidinediones and edema: recent advances in the pathogenesis of thiazolidinediones-induced renal sodium retention.
        PPAR Res. 2015; 2015646423
        • Zhu ZN
        • Jiang YF
        • Ding T.
        Risk of fracture with thiazolidinediones: an updated meta-analysis of randomized clinical trials.
        Bone. 2014; 68: 115-123
        • Unnikrishnan AG
        • Kalra S
        • Purandare V
        • Vasnawala H.
        Genital infections with sodium glucose cotransporter-2 inhibitors: occurrence and management in patients with type 2 diabetes mellitus.
        Indian J Endocrinol Metab. 2018; 22: 837-842
        • Toeller M.
        α-Glucosidase inhibitors in diabetes: efficacy in NIDDM subjects.
        Eur J Clin Invest. 1994; 24: 31-35
        • Jin J
        • Sklar GE
        • Oh VMS
        • Li SC.
        Factors affecting therapeutic compliance: a review from the patient's perspective.
        Ther Clin Risk Manag. 2008; 4: 269-286
        • MacDonald IJ
        • Chen YH.
        The endocannabinoid system contributes to electroacupuncture analgesia.
        Front Neurosci. 2020; 14594219
        • Han X
        • Gao Y
        • Yin X
        • Zhang Z
        • Lao L
        • Chen Q
        • et al.
        The mechanism of electroacupuncture for depression on basic research: a systematic review.
        Chin Med. 2021; 16: 1-17
        • Amorim D
        • Amado J
        • Brito I
        • Fiuza SM
        • Amorim N
        • Costeira C
        • et al.
        Acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research.
        Complement Ther Clin Pract. 2018; 31: 31-37
        • Chen JDZ
        • Ni M
        • Yin J.
        Electroacupuncture treatments for gut motility disorders.
        Neurogastroenterol Motil. 2018; 30: e13393
        • Lin JG
        • Chen WC
        • Hsieh CL
        • Tsai CC
        • Cheng YW
        • Cheng JT
        • et al.
        Multiple sources of endogenous opioid peptide involved in the hypoglycemic response to 15 Hz electroacupuncture at the Zhongwan acupoint in rats.
        Neurosci Lett. 2004; 366: 39-42
        • Chang S
        • Lin J
        • Chi T
        • Liu I
        • Cheng J
        An insulin-dependent hypoglycaemia induced by electroacupuncture at the Zhongwan (CV12) acupoint in diabetic rats.
        Diabetologia. 1999; 42: 250-255
        • Kumar R
        • Mooventhan A
        • Manjunath NK.
        Immediate effect of needling at CV-12 (Zhongwan) acupuncture point on blood glucose level in patients with type 2 diabetes mellitus: a pilot randomized placebo-controlled trial.
        J Acupunct Meridian Stud. 2017; 10: 240-244
        • Yin J
        • Kuang J
        • Chandalia M
        • Tuvdendorj D
        • Tumurbaatar B
        • Abate N
        • et al.
        Hypoglycemic effects and mechanisms of electroacupuncture on insulin resistance.
        Am J Physiol Regul Integr Comp Physiol. 2014; 307: R332-R339
        • Chang SL
        • Tsai CC
        • Lin JG
        • Hsieh CL
        • Lin RT
        • Cheng JT.
        Involvement of serotonin in the hypoglycemic response to 2 Hz electroacupuncture of zusanli acupoint (ST36) in rats.
        Neurosci Lett. 2005; 379: 69-73
        • Lee YC
        • Li TM
        • Tzeng CY
        • Chen YI
        • Ho WJ
        • Lin JG
        • et al.
        Electroacupuncture at the Zusanli (ST-36) acupoint induces a hypoglycemic effect by stimulating the cholinergic nerve in a rat model of streptozotocine-induced insulin-dependent diabetes mellitus.
        Evid Based Complement Alternat Med. 2011; 2011650263
        • Miller DL
        • Smith NB
        • Bailey MR
        • Czarnota GJ
        • Hynynen K
        • Makin IRS
        • et al.
        Overview of therapeutic ultrasound applications and safety considerations.
        J Ultrasound Med. 2012; 31: 623-634
        • Castellanos IS
        • Jeremic A
        • Cohen J
        • Zderic V.
        Ultrasound stimulation of insulin release from pancreatic beta cells as a potential novel treatment for type 2 diabetes.
        Ultrasound Med Biol. 2017; 43: 1210-1222
        • Suarez Castellanos I
        • Singh T
        • Chatterjee Bhowmick D
        • Cohen J
        • Jeremic A
        • Zderic V
        Effect of therapeutic ultrasound on the release of insulin, glucagon, and alpha-amylase from ex vivo pancreatic models.
        J Ultrasound Med. 2021; 40: 2709-2719
        • Singh T
        • Castellanos IS
        • Bhowmick DC
        • Cohen J
        • Jeremic A
        • Zderic V.
        Therapeutic ultrasound-induced insulin release in vivo.
        Ultrasound Med Biol. 2020; 46: 639-648
        • Razavi M
        • Zheng F
        • Telichko A
        • Wang J
        • Ren G
        • Dahl J
        • et al.
        Improving the function and engraftment of transplanted pancreatic islets using pulsed focused ultrasound therapy.
        Sci Rep. 2019; 9: 1-12
        • Razavi M
        • Zheng F
        • Telichko A
        • Ullah M
        • Dahl J
        • Thakor AS.
        Effect of pulsed focused ultrasound on the native pancreas.
        Ultrasound Med Biol. 2020; 46: 630-638
        • Cotero V
        • Graf J
        • Miwa H
        • Hirschstein Z
        • Qanud K
        • TsS Huerta
        • et al.
        Stimulation of the hepatoportal nerve plexus with focused ultrasound restores glucose homoeostasis in diabetic mice, rats and swine.
        Nat Biomed Eng. 2022; 6: 683-705
        • Shieh J
        • Chen SR
        • Chen GS
        • Lo CW
        • Chen CS
        • Chen BT
        • et al.
        Acrylic acid controlled reusable temperature-sensitive hydrogel phantoms for thermal ablation therapy.
        Appl Therm Eng. 2014; 62: 322-329
        • Srinivasan K
        • Viswanad B
        • Asrat L
        • Kaul CL
        • Ramarao P.
        Combination of high-fat diet-fed and low-dose streptozotocin-treated rat: a model for type 2 diabetes and pharmacological screening.
        Pharmacol Res. 2005; 52: 313-320
        • Chao PC
        • Li Y
        • Chang CH
        • Shieh JP
        • Cheng JT
        • Cheng KC.
        Investigation of insulin resistance in the popularly used four rat models of type-2 diabetes.
        Biomed Pharmacother. 2018; 101: 155-161
        • Zhang M
        • Lv XY
        • Li J
        • Xu ZG
        • Chen L.
        The characterization of high-fat diet and multiple low-dose streptozotocin induced type 2 diabetes rat model.
        Exp Diabetes Res. 2008; 2008704045
        • Alberti KGMM
        • Zimmet PZ.
        Definition, diagnosis and classification of diabetes mellitus and its complications: Part 1. Diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation.
        Diabetic Med. 1998; 15: 539-553
        • Yin CS
        • Jeong HS
        • Park HJ
        • Baik Y
        • Yoon MH
        • Choi CB
        • et al.
        A proposed transpositional acupoint system in a mouse and rat model.
        Res Vet Sci. 2008; 84: 159-165
        • Okita K
        • Iwahashi H
        • Kozawa J
        • Okauchi Y
        • Funahashi T
        • Imagawa A
        • et al.
        Usefulness of the insulin tolerance test in patients with type 2 diabetes receiving insulin therapy.
        J Diabetes Investig. 2014; 5: 305-312
        • Nagy C
        • Einwallner E.
        Study of in vivo glucose metabolism in high-fat diet-fed mice using oral glucose tolerance test (OGTT) and insulin tolerance test (ITT).
        J Vis Exp. 2018; 131: 56672
        • Stumvoll M
        • Mitrakou A
        • Pimenta W
        • Jenssen T
        • Yki-Järvinen H
        • Van Haeften T
        • et al.
        Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity.
        Diabetes Care. 2000; 23: 295-301
        • Wu B
        • Yu Z
        • You S
        • Zheng Y
        • Liu J
        • Gao Y
        • et al.
        Physiological disturbance may contribute to neurodegeneration induced by isoflurane or sevoflurane in 14 day old rats.
        PLoS One. 2014; 9: e84622
        • Curry DL
        • Bennett LL
        • Li CH.
        Stimulation of insulin secretion by beta-endorphins (I-27 & I-31).
        Life Sci. 1987; 40: 2053-2058
        • Giugliano D
        • Cozzolino D
        • Salvatore T
        • Torella R
        • D'Onofrio F
        β-Endorphin-induced inhibition and stimulation of insulin secretion in normal humans is glucose dependent.
        Diabetes. 1988; 37: 1265-1270
        • Wang X
        • Shi H
        • Shang H
        • Su Y
        • Xin J
        • He W
        • et al.
        Are primo vessels (PVs) on the surface of gastrointestine involved in regulation of gastric motility induced by stimulating acupoints ST36 or CV12?.
        Evid Based Complement Alternat Med. 2012; 2012787683
        • Draper DO
        • Castel JC
        • Castel D.
        Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound.
        J Orthop Sports Phys Ther. 1995; 22: 142-150
        • Wolever TM.
        Carbohydrate and the regulation of blood glucose and metabolism.
        Nutr Rev. 2003; 61: S40-S48
        • Yin T
        • Coudyzer W
        • Peeters R
        • Liu Y
        • Cona MM
        • Feng Y
        • et al.
        Three-dimensional contrasted visualization of pancreas in rats using clinical MRI and CT scanners.
        Contrast Media Mol Imaging. 2015; 10: 379-387
        • U.S. Food and Drug Administration (FDA)
        Marketing clearance of diagnostic ultrasound systems and transducers: guidance for industry and Food and Drug Administration staff.
        FDA, Silver Spring, MD2019: 1-60
        • Dimitriadis GD
        • Maratou E
        • Kountouri A
        • Board M
        • Lambadiari V.
        Regulation of postabsorptive and postprandial glucose metabolism by insulin-dependent and insulin-independent mechanisms: an integrative approach.
        Nutrients. 2021; 13: 159
        • Gheibi S
        • Kashfi K
        • Ghasemi A.
        A practical guide for induction of type-2 diabetes in rat: incorporating a high-fat diet and streptozotocin.
        Biomed Pharmacother. 2017; 95: 605-613
        • Thomas HE
        • McKenzie MD
        • Angstetra E
        • Campbell PD
        • Kay TW.
        Beta cell apoptosis in diabetes.
        Apoptosis. 2009; 14: 1389-1404