Methodological considerations regarding the combination of acupuncture and anti-inflammatory diet for depression in type 2 diabetes

We read with great interest the study by Irandoost et al. [1] entitled “ The effects of an anti-in fl ammatory diet alone or in combination with acupuncture on mental health, anthropometric indices, and metabolic status in diabetic patients with depression: a randomized, controlled clinical trial. ” This study investigates the potential of acupuncture to enhance both the physical and mental health of patients with type 2 diabetes mellitus who also experience mild to moderate depression. This topic holds signi fi cant clinical value and offers a robust research framework for evaluating the therapeutic ef fi cacy of acupuncture. However, after a thorough review of the study ’ s design and data interpretation, we identify several issues that require further re fi nement in future related research. First, this study lacks a sham acupuncture control group, which may hinder the ability to exclude placebo effects and attention bias [2]. Although the paper states that “ complete blinding was unfeasible due to the nature of the intervention, ” the absence of a sham acupuncture group prevents us from determining whether the reduction in depression scores (MADRS) is attributable to the speci fi c physiological effects of acupoints or merely to the non-speci fi c psychological effects of “ being treated ”— that is, the placebo effect. Secondly, the study reported that after an 8-week intervention, the combined treatment group exhibited a signi fi cant reduction in glycated hemoglobin (HbA1c) levels. HbA1c serves as an indicator of the average blood glucose levels throughout the lifespan of red blood cells, which is approximately 120 days. While the intensive 8-week intervention may begin to in fl uence HbA1c, the signi fi cant changes observed within such a brief timeframe, along with the absence of statistically signi fi cant differences in fasting blood