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The meta-analysis found that needles under 1 mm produced a larger pooled effect (SMD: 1.16) than needles over 1 mm (SMD: 0.52)

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Microvascular complications are equally driven by oxidative damage i.e., in diabetic retinopathy, ROS-induced VEGF overexpression through HIF-1α stabilization leads to pathological angiogenesis (Kowluru and Mishra, 2017), while in diabetic nephropathy, podocyte injury results from NOX4-derived O 2 • − and mitochondrial ROS-mediated apoptosis (Jha et al., 2024)