The Effect of Acupuncture on Glucose Metabolism and Lipid Profiles in Patients with PCOS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zheng, Ruqun; Qing, Peng; Han, Mei; Song, Jinlong; Hu, Min; Ma, Hongxia; Li, Juan

doi:10.1155/2021/5555028

Cited by 21 publications

(20 citation statements)

References 43 publications

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“…The findings of Wu et al (2017) did not support acupuncture as an infertility treatment in anovulatory women with PCOS. Systematic reviews and some studies have demonstrated that electroacupuncture has the potential to increase whole-body glucose uptake and to improve insulin sensitivity through the activation of the sympathetic and, partly, the parasympathetic nervous systems in women with PCOS or in animal models ( Liang and Koya, 2010 ; Benrick et al , 2017 ; Zheng et al , 2021 ). Our prospective pilot studies showed that acupuncture also has a significant effect on the homeostatic model assessment of insulin resistance (HOMA-IR) in women with PCOS and IR after 5 weeks, and after 6 months of treatment ( Zheng et al , 2015 ; Stener-Victorin et al , 2016 ; Li et al , 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial

Wen

Lai

et al. 2021

Human Reproduction

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STUDY QUESTION Does acupuncture improve insulin sensitivity more effectively than metformin or sham acupuncture in women with polycystic ovary syndrome (PCOS) and insulin resistance (IR)? SUMMARY ANSWER Among women with PCOS and IR, acupuncture was not more effective than metformin or sham acupuncture in improving insulin sensitivity. WHAT IS KNOWN ALREADY Uncontrolled trials have shown that acupuncture improved insulin sensitivity with fewer side effects compared with metformin in women with PCOS and IR. However, data from randomized trials between acupuncture and metformin or sham acupuncture are lacking. STUDY DESIGN, SIZE, DURATION This was a three-armed randomized controlled trial enrolling a total of 342 women with PCOS and IR from three hospitals between November 2015 and February 2018, with a 3-month follow-up until October 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged from 18 to 40 years with PCOS and homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.14 were randomly assigned (n = 114 per group) to receive true acupuncture plus placebo (true acupuncture), metformin plus sham acupuncture (metformin, 0.5 g three times daily) or sham acupuncture plus placebo (sham acupuncture) for 4 months, with an additional 3-month follow-up. True or sham acupuncture was given three times per week, and 0.5 g metformin or placebo was given three times daily. The primary outcome was change in HOMA-IR from baseline to 4 months after baseline visit. Secondary outcomes included changes in the glucose AUC during an oral glucose tolerance test, BMI and side effects at 4 months after baseline visit. MAIN RESULTS AND THE ROLE OF CHANCE After 4 months of treatment, the changes of HOMA-IR were –0.5 (decreased 14.7%) in the true acupuncture group, –1.0 (decreased 25.0%) in the metformin group and –0.3 (decreased 8.6%) in the sham acupuncture group, when compared with baseline. True acupuncture is not as effective as metformin in improving HOMA-IR at 4 months after baseline visit (difference, 0.6; 95% CI, 0.1–1.1). No significant difference was found in change in HOMA-IR between true and sham acupuncture groups at 4 months after baseline visit (difference, –0.2; 95% CI, –0.7 to 0.3). During the 4 months of treatment, gastrointestinal side effects were more frequent in the metformin group, including diarrhea, nausea, loss of appetite, fatigue, vomiting and stomach discomfort (31.6%, 13.2%, 11.4%, 8.8%, 14.0% and 8.8%, respectively). Bruising was more common in the true acupuncture group (14.9%). LIMITATIONS, REASONS FOR CAUTION This study might have underestimated the sample size in the true acupuncture group with 4 months of treatment to enable detection of statistically significant changes in HOMA-IR with fixed acupuncture (i.e. a non-personalized protocol). Participants who withdrew because of pregnancy did not have further blood tests and this can introduce bias. WIDER IMPLICATIONS OF THE FINDINGS True acupuncture did not improve insulin sensitivity as effectively as metformin in women with PCOS and IR, but it is better than metformin in improving glucose metabolism (which might reduce the risk of type 2 diabetes) and has less side effects. Metformin had a higher incidence of gastrointestinal adverse effects than acupuncture groups, and thus acupuncture might be a non-pharmacological treatment with low risk for women with PCOS. Further studies are needed to evaluate the effect of acupuncture combined with metformin on insulin sensitivity in these women. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants 2017A020213004 and 2014A020221060 from the Science and Technology Planning Project of Guangdong Province. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER Clinicaltrials.gov number: NCT02491333. TRIAL REGISTRATION DATE 8 July 2015. DATE OF FIRST PATIENT’S ENROLLMENT 11 November 2015.

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Section: Introductionmentioning

confidence: 99%

Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial

Wen

Lai

et al. 2021

Human Reproduction

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“…Acupuncture harmonizes the "Yin" and "Yang" and dredges the channels of "Qi" and "Blood" for treating diseases. Due to its safety and few side effects, acupuncture has been well-received in treating various diseases and symptoms, especially chronic metabolic illnesses [26,27] , and acupuncture has been reported to be a relatively effective and safe method for improving glucose metabolism and insulin sensitivity in patients with PCOS [28] . EA effectively ameliorated abdominal obesity and metabolic disorders in HFD-induced abdominally obese rats [29] , and clinical trials have indicated that EA can decrease the levels of ALT, AST, and TG in female patients suffering from nonalcoholic fatty liver disease, suggesting that this approach might be an important treatment for improving liver functions in these patients [30] .…”

Section: Discussionmentioning

confidence: 99%

Three-Dimentional Visualization of Electroacupuncture Activates Brown Adipose Tissue via Sympathetic Innervation in PCOS Rats

Gao

Tong

et al. 2022

Preprint

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Background: Low-frequency electroacupuncture (EA) has been shown to ameliorate obesity and reproductive dysfunctions in patients with polycystic ovary syndrome (PCOS), and further explorations in PCOS-like rats showed that EA could affect white adipose tissue (WAT). However, the function and neuromodulation of brown adipose tissue (BAT) in PCOS and after EA treatment have remained unknown. The present study focused on the role of BAT in PCOS-like rats and its relationship with EA, and it characterized the three-dimensional (3D) innervation of BAT associated with activation molecules. Methods: Twenty-one-day-old female rats were implanted with dihydrotestosterone or fed high fat diet respectively to establish PCOS-like and obesity models, and then EA treatment at “Guilai” (ST 29) and “Sanyinjiao” (SP 6) was carried out for 4 weeks. In present study, morphology, 3D imaging, molecular biology and other experimental techniques were used to study the sympathetic nerve and activity of BAT. Results: First, dihydrotestosterone-induced PCOS-like rats showed both obvious weight gain and reproductive dysfunction, similar to what is seen in high-fat dietinduced obesity rats except for the absence of reproductive dysfunction. We found that the body weight gain was mainly caused by an increase in WAT, but surprisingly we also observed an abnormal decrease in BAT. Because both the lipid metabolism and reproductive disorders could be improved with bilateral EA at “Guilai” (ST 29) and “Sanyinjiao” (SP 6), especially the restoration of BAT, we further investigated the neuromodulation and inflammation in BAT and identified the sympathetic marker tyrosine hydroxylase as one of the key factors of sympathetic nerves. We used tissue clearing and 3D high-resolution imaging technology to show that crooked or dispersed sympathetic nerves, but not the twisted vasculature, were reconstructed and associated with the activation of BAT and are likely to be the functional target for EA treatment. Conclusion: Taken together, the results of our study highlight the significant role of BAT and its sympathetic innervations in PCOS and in EA therapy. Keywords: polycystic ovary syndrome, electroacupuncture, brown adipose tissue, sympathetic nerve, mitochondrial brown fat uncoupling protein 1

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“…Correlation meta-analysis has shown that acupuncture has a beneficial effect on IR and fewer adverse reactions than other treatments [6,7]. A recent meta-analysis also found that acupuncture can improve IR in patients with PCOS [8]. However, this evidence is inadequate because of the poor quality and methodology of the included studies.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of acupuncture for insulin resistance in women with polycystic ovary syndrome: A systematic review and meta-analysis

Liu

Fan

et al. 2022

Preprint

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Objective. To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate acupuncture’s clinical effect of on insulin resistance (IR) in women with polycystic ovary syndrome (PCOS). Methods. PubMed, Cochrane Library, Embase databases, and Chinese databases, including China National Knowledge Infrastructure (CNKI), Technology Journal Database (VIP), and Wanfang Database, were searched without language restrictions from inception to 20 December 2021. Only RCTs in which acupuncture had been examined as the sole or adjunctive PCOS-IR treatment were included. Additionally, only studies in Chinese databases that had been published in core journals of Peking University were included. Our primary endpoint was homeostasis model assessment of insulin resistance (HOMA-IR). The secondary outcomes were fasting blood glucose (FBG), 2-h postprandial blood glucose (2h-PBG), fasting insulin (FINS), body mass index (BMI), and adverse events. A random-effects model enabled reporting of differences between groups as mean differences, thus minimizing the effects of uncertainty associated with inter-study variability on the effects of different interventions. Results. Our analysis included seven eligible RCTs (N=728 participants). Compared with other treatments, acupuncture therapy yielded a greater mean reduction in BMI (−1.21; 95% CI, −2.41 to −0.02; P=0.05). No significant differences existed between acupuncture and other studied treatments for changes in HOMA-IR (−0.33; 95% CI, −0.87 to 0.22; P>0.05), FBG (−0.43; 95% CI, −0.88 to 0.03; P=0.07), 2h-PBG (−0.40; 95% CI, −0.90 to 0.10; P>0.05), and FINS (−0.65; 95% CI, −2.18 to 0.89; P>0.05). Furthermore, compared with medication alone, a combination of acupuncture and medication yielded a mean reduction in HOMA-IR of −0.63 (95% CI, −1.12 to −0.14; P=0.01) and BMI of −1.36 (95% CI, −2.07 to −0.66; P<0.01). Conclusion. Although acupuncture is not more effective than metformin, the former could be an adjuvant strategy for improving PCOS-IR. Further large-scale, long-term RCTs with strict methodological standards are justified.

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The Effect of Acupuncture on Glucose Metabolism and Lipid Profiles in Patients with PCOS: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 21 publications

References 43 publications

Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial

Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial

Three-Dimentional Visualization of Electroacupuncture Activates Brown Adipose Tissue via Sympathetic Innervation in PCOS Rats

Effectiveness and safety of acupuncture for insulin resistance in women with polycystic ovary syndrome: A systematic review and meta-analysis

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