Objective To observe the effects of repetitive transcranial magnetic stimulation (rTMS) combined with electroacupuncture on cognitive function and Caspase‑3 expression in the hippocampal CA1 region of rats with diabetic encephalopathy (DE). Methods A total of 84 SD rats were randomly assigned to sham‑operation group (n=24) or DE model group (n=60). In the DE model group, the DE model was established by feeding a high‑fat and high‑sugar diet combined with intraperitoneal injection of Streptozotocin. At the 4th week after intraperitoneal injection of Streptozotocin, cognitive function was detected using the Morris water maze test to confirm successful DE modeling. Rats in the DE model group were then randomly divided into non‑intervention group (n=24), rTMS group (n=18), or rTMS+electroacupuncture group (n=18). The rTMS group received rTMS intervention, while the rTMS+electroacupuncture group received electroacupuncture in addition to rTMS. All interventions were administered continuously for 21 days. Spatial learning and memory abilities were detected using the Morris water maze test after 21 days of intervention. The SABC immunohistochemistry method was employed to detect Caspase‑3 expression (integrated optical density ［IOD］) in the hippocampal CA1 region in various groups before intervention and at 7, 14, and 21 days after intervention. Results Compared with the non‑intervention group, both the rTMS group and the rTMS+electroacupuncture group exhibited shortened escape latency, increased swimming time in the original platform quadrant, and increased number of platform crossings (P<0.05). Compared with the rTMS group, the rTMS+electroacupuncture group exhibited shortened escape latency, increased swimming time in the original platform quadrant, and increased number of platform crossings (P<0.05). At all post‑intervention time points, the IOD in the non‑intervention group was higher than those in the sham‑operation group; furthermore, the IOD in both the rTMS group and the rTMS+electroacupuncture group was lower than those in the non‑intervention group, and the rTMS+electroacupuncture group depicted lower IOD as compared with the rTMS group (P<0.05). In the rTMS group, IOD decreased successively with prolonged intervention time (P<0.05). In the rTMS+electroacupuncture group, IOD at 14 and 21 days after intervention was lower than those at 7 days after intervention (P<0.05), but no statistically significant difference was found in IOD between 14 and 21 days after intervention (P>0.05). Conclusion Combined rTMS and electroacupuncture therapy can effectively improve cognitive function in DE rats and inhibit the apoptotic⁃associated factor Caspase‑3 expression in the hippocampal CA1 region, with superior effects compared to rTMS therapy alone.

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