Objective To systematically evaluate the efficacy of acupuncture-moxibustion in the treatment of diabetic gastroparesis in recent 6 years. Methods The CNKI, VIP, WanFang, CBM, Pubmed, Embase, Cochrane Library databases were searched. Randomized controlled trials on acupuncture-moxibustion on diabetic gastroparesis were screened. The retrieval time was from March of 2015 to January of 2021. Two researchers assessed risk of bias included in the test according to the Cochrane Handbook 5.1.0 standard, and used RevMan 5.3 software for Meta analysis. Results A total of 16 RCTs involving 1403 patients were included. Meta-analysis showed that the total effective rate of clinical symptoms were improved in the acupuncture-moxibustion group compared with the western medicine group [RR=1.23, 95％CI(1.17,1.29), P＜0.000 01)]. The subgroup analysis showed that the total effective rate of acupuncture, electroacupuncture and needle warming moxibustion was higher than that of the western medicine group, and the best possibility of intervention is electroacupuncture(1.30) > needle warming moxibustion(1.28) > acupuncture(1.2). The confidence interval of symptom scores was narrow, and the effect direction was consistent with the acupuncture-moxibustion group and did not intersect with the invalid line. The gastric residue of small barium strips was less [WMD=-3.11 ,95％CI(-3.43,-2.80), P＜0.000 01)]. The effect of reducing gastrin and motilin in the acupuncture-moxibustion group was more obvious [WMD=-28，95％CI(-45.92，-10.07), P＜0.000 01]、[WMD=-82.66，95％CI(-115.78，-49.55), P＜0.000 01]. There were 5 articles about 39 cases of adverse events, including 18 cases in acupuncture-moxibustion group and 21 cases in western medicine group. Conclusion Acupuncture-moxibustion is better than conventional western medicine in treating diabetic gastroparesis, which can improve the clinical symptoms and gastric motility of patients. Further verification of high quality and large sample RCT is urgently needed.