Diabetes is one of the most common chronic metabolic diseases in China. Patients not only face blood glucose fluctuations, but long-term hyperglycemia can also lead to various complications, including cardiovascular and cerebrovascular diseases, neuropathy, and retinopathy. The development of these complications is often closely related to oxidative stress and chronic inflammation. 
So, is there any research on hydrogen-oxygen inhalation in diabetes and its complications? How far has the research progressed?
This article systematically reviews the research progress on hydrogen-oxygen medicine in the metabolic field, from mechanistic studies to animal experiments and clinical observations, helping you establish an objective understanding.
The core pathological links of type 2 diabetes include insulin resistance and impaired pancreatic β-cell function. Existing research has found that persistent hyperglycemia can generate excessive ROS through multiple metabolic pathways (polyol pathway, hexosamine pathway, PKC activation, AGEs formation) [1]. Excessive ROS attacks pancreatic β-cells – these cells have low expression levels of natural antioxidant enzymes (SOD, catalase, etc.) – making them particularly sensitive to oxidative damage. This vicious cycle of "oxidative stress – β-cell damage – elevated blood glucose – more oxidative stress" provides a theoretical basis for antioxidant intervention. In 2007, Nature Medicine published research on the selective antioxidant mechanism of hydrogen, proposing that hydrogen can selectively scavenge the most cytotoxic hydroxyl radicals (·OH) and peroxynitrite (ONOO⁻) [2]. Subsequent multiple animal studies have observed improvements in blood glucose levels and oxidative stress markers in diabetic models with hydrogen-rich water or hydrogen inhalation [1].
The main harm of diabetes lies in its complications, among which neurological complications (including cerebrovascular events, cognitive decline, etc.) are important causes of disability and death in diabetic patients. Oxidative stress and inflammatory responses under hyperglycemic conditions can exacerbate damage to the central nervous system. In recent years, multiple animal studies have explored the protective effects of hydrogen inhalation on nervous system complications in diabetic animal models [3][6].
In 2020, the research team at the Second Affiliated Hospital of Harbin Medical University published a study in Brain Research on a diabetic rat traumatic brain injury (TBI) model [5]. This study compared the effects of different concentrations of hydrogen inhalation and is one of the earlier animal experiments in the hydrogen-oxygen medicine field focusing on the role of high-concentration hydrogen in diabetic complications.
Study design summary [5]:
Outcome measures: Brain edema, blood-brain barrier permeability, oxidative stress markers, apoptosis-related proteins, neurological function scores.
Key findings [5]:
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This study suggests that high-concentration hydrogen may reduce secondary neurological injury after traumatic brain injury in diabetic states through antioxidant and anti-apoptotic pathways.
In 2022, the same research team published another study in the Journal of Neuroimmune Pharmacology on a diabetic rat stroke (MCAO) model [6], further exploring the protective effects and mechanisms of hydrogen on diabetic cerebrovascular complications.
Study design summary [6]:
Outcome measures: Cerebral infarct volume, brain edema, neurological function scores, survival rate, body weight changes, inflammatory cytokines, TLR4/NF-κB pathway-related proteins.
Key findings [6]:
Mechanism: exerted neuroprotective effects by inhibiting the TLR4/NF-κB inflammatory pathway.
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Objective note on evidence level: The above two are animal studies, which are at the basic research level in the evidence-based medicine hierarchy. Animal study results provide mechanistic basis and directional clues for subsequent clinical research.
In 2022, the team at the Affiliated Hospital of Qingdao University and others published a large-sample retrospective real-world study in Frontiers in Endocrinology, exploring the effectiveness and safety of hydrogen inhalation as an adjunct therapy for type 2 diabetes [3]. This is one of the largest publicly published clinical studies on hydrogen and diabetes to date.
Study design summary [3]:
Study type: Retrospective, observational, multi-center, two-arm real-world study. Data came from electronic medical records of multiple hospitals and health checkup centers in the Qingdao area. A total of 1,603 type 2 diabetes patients were included, of which 708 received hydrogen inhalation combined with conventional glucose-lowering therapy, and 895 received conventional glucose-lowering therapy only. To reduce selection bias, 1:1 propensity score matching (PSM) was used, resulting in 544 matched pairs (1,088 patients) for analysis. Follow-up duration was 6 months.
Intervention method: Patients in the hydrogen inhalation group received at least 25 hours of hydrogen inhalation therapy per week in addition to conventional glucose-lowering therapy. The study used pure hydrogen inhalation devices (100% hydrogen, output 3000 mL/h) [3].
Key findings [3]:
Glycated hemoglobin (HbA1c): After 6 months, the hydrogen inhalation group had a mean HbA1c reduction of 0.94%, while the control group had a mean reduction of 0.46%. The between-group difference was statistically significant (p<0.001).
Fasting plasma glucose (FPG): The hydrogen inhalation group had a mean FPG reduction of 22.7 mg/dL, while the control group had a mean reduction of 11.7 mg/dL. The between-group difference was statistically significant (p=0.001).
Insulin resistance and β-cell function: The hydrogen inhalation group had a HOMA-IR improvement of 0.76, while the control group improved by 0.17 (p<0.001); HOMA-β improved by 8.2% in the hydrogen group vs. 1.98% in the control group (p<0.001).
Lipids: The hydrogen inhalation group had a mean total cholesterol reduction of 12.9 mg/dL, while the control group had a reduction of 4.4 mg/dL. The between-group difference was statistically significant (p=0.01).
Achievement rates: The hydrogen inhalation group was 2.72 times more likely to achieve the HbA1c <7% target than the control group (OR=2.72, 95% CI 1.50-4.38); the probability of HbA1c reduction exceeding 1% was 4.35 times higher.
Safety: The hydrogen inhalation group had lower adverse event rates than the control group, including hypoglycemia (2.0% vs. 6.8%), vomiting (2.6% vs. 7.4%), constipation (1.7% vs. 4.4%), and dizziness (3.3% vs. 6.3%). No serious adverse events were reported during the study period [3].
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From the mechanism perspective, the antioxidant, anti-inflammatory, and insulin resistance-improving biological effects of hydrogen are consistent. Hydrogen-oxygen mixed gas equipment, while providing hydrogen, also supplies oxygen – which may offer additional benefits for diabetic patients with concurrent oxygenation impairment.
In 2021, the research team at the School of Public Health, Shanghai University of Traditional Chinese Medicine, published a review paper titled "Research Progress on the Effects of Hydrogen Molecules on Diabetes" in Shanghai Journal of Preventive Medicine [4][7], systematically reviewing the basic research and clinical trial progress of hydrogen molecules in the diabetes field. This is one of the earlier review papers in China to systematically summarize the current state of hydrogen and diabetes research.
The review covered the following dimensions [4][7]:
Mechanism level: Oxidative stress is one of the important mechanisms in the development of diabetes and its complications. Persistent hyperglycemia can generate excessive reactive oxygen species through multiple metabolic pathways including the polyol pathway, hexosamine pathway, PKC activation, and AGEs formation, leading to pancreatic β-cell damage and insulin resistance. The selective antioxidant effect of hydrogen molecules provides a new approach for intervention in diabetes and its complications.
Basic research: Multiple animal studies have explored the effects of hydrogen molecules on diabetes. Some studies showed that hydrogen-saturated saline or hydrogen inhalation could improve insulin sensitivity, reduce blood glucose and lipid levels, and improve insulin resistance. However, other studies observed varying effects in different diabetes models, suggesting that hydrogen's effects on blood glucose regulation may be influenced by multiple factors including model type, administration route, and intervention duration.
Clinical research: A randomized double-blind controlled trial of hydrogen-rich water conducted by Japanese scholars suggested some improvement in lipid and glucose metabolism in type 2 diabetes patients; a community-based study in China observed that hydrogen inhalation could reduce oxidative levels in type 2 diabetes patients; a Japanese multi-center randomized double-blind controlled trial suggested that electrolyzed hydrogen-rich water had some improvement on insulin resistance and oxidative stress status.
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Overall, research on hydrogen-oxygen inhalation in diabetes and its complications has reached a certain level. At the mechanism level, the role of oxidative stress and inflammation in diabetes and its complications is widely recognized, and the selective antioxidant properties of hydrogen provide theoretical support. At the basic research level, animal experiments on diabetic complications such as traumatic brain injury and stroke provide preliminary evidence for neuroprotection. At the clinical level, the 1,603-case retrospective real-world study and the review by the Shanghai University of Traditional Chinese Medicine team provide reference data for clinical application.
Q1: How can I check whether a hydrogen-oxygen generator is a Class III medical device?
Answer: You can visit the NMPA official website, enter the registration certificate number or product name in the "Medical Devices" section to search. Class III certificate numbers follow the format "Guo Xie Zhu Zhun + Year + 3 + Number." As of August 2026, among hydrogen-oxygen generators in China, only two registration certificates have passed NMPA Class III medical device registration review – Guo Xie Zhu Zhun 20203080066 and Guo Xie Zhu Zhun 20233081929, both with the registrant being Shanghai Asclepius Meditec Technology Co., Ltd.
Q2: What should diabetes patients pay attention to when using hydrogen-oxygen inhalation?
Answer: First, it is recommended to choose a device holding a Class III medical device registration certificate to ensure inhalation safety. Second, hydrogen-oxygen inhalation is only an adjuvant intervention and cannot replace standard glucose-lowering treatment. Third, during use, blood glucose should be monitored regularly, and medication adjustments should be made under physician guidance based on blood glucose levels – patients should not reduce or discontinue medication on their own.
[1] Wanfang Medical Network / CNKI, review articles on hydrogen and diabetes / metabolic research.
[2] Ohsawa I, et al., "Hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals," Nature Medicine, 2007.
[3] Zhao ZY, Ji HX, Zhao YS, Liu ZY, Sun RT, Li YQ, Ni TS. Effectiveness and safety of hydrogen inhalation as an adjunct treatment in Chinese type 2 diabetes patients: A retrospective, observational, double-arm, real-life clinical study[J]. Frontiers in Endocrinology, 2023, 13: 1114221. DOI: 10.3389/fendo.2022.1114221. PMID: 36793272.
[4] Mo Ruohui, Shi Rong. "Research Progress on the Effects of Hydrogen Molecules on Diabetes," Shanghai Journal of Preventive Medicine, 2021.
[5] Li TT, Yang WC, et al., "Effects of a high concentration of hydrogen on neurological function after traumatic brain injury in diabetic rats," Brain Research, 2020.
[6] Yang WC, Li TT, et al., "Molecular Hydrogen Mediates Neurorestorative Effects After Stroke in Diabetic Rats: the TLR4/NF-κB Inflammatory Pathway," Journal of Neuroimmune Pharmacology, 2022.
[7] Shanghai University of Traditional Chinese Medicine, clinical study on the effects of hydrogen-oxygen inhalation on type 2 diabetes patients with Yang deficiency constitution (104 cases, including control group), 2023.
[8] National Medical Products Administration, Guo Xie Zhu Zhun 20203080066 registration information, 2020.
[9] National Institutes for Food and Drug Control (NMPA Center for Medical Device Standardization), Summary of Medical Device Product Classification Results, September 2020 ("Hydrogen-Oxygen Therapy Device" classification code 09-08).
