Is Acupuncture Effective for Improving Insulin Resistance? A Systematic Review and Meta-analysis

Abstract

This study aimed to evaluate the clinical efficacy of acupuncture for intervening insulin resistance (IR) by meta-analysis of related randomized controlled trials (RCTs). Studies published prior to 31 January 2018 were searched on Pubmed, Medline, Cochrane Library, Embase databases and Chinese databases. Only RCTs, which examined acupuncture as the sole or adjunctive treatment for IR-related diseases, were included. The primary outcome was homeostasis model assessment for insulin resistance (HOMA-IR). The secondary outcomes consisted of fasting blood glucose (FBG), fasting insulin (FINS) and 2-h postprandial blood glucose (2h-PBG). The differences between groups were reported as mean differences (MD). All statistical analyses were performed using RevMan software 5.3. After carefully screening relevant studies, 9 RCTs involving 562 patients (279 in experimental group and 283 in control group) were enrolled in this study. The pooled results showed that acupuncture had significant effects on HOMA-IR (MD 0.70, 95% CI 0.04 to 1.35, P=0.04<0.05), FINS (MD 3.35 mU/L, 95% CI 1.99 to 4.7, P<0.001) and 2h-PBG (MD 1.03 mmol/L, 95% CI 0.25 to 1.82, P=0.01). However, the differences in FBG were not significant (MD 0.28 mmol/L, 95% CI–0.28 to 0.84, P=0.32>0.05). The present meta-analysis indicated that acupuncture can help to improve IR to a certain extent, which remains to be confirmed by further high-quality RCTs.

Keywords

acupuncture / insulin resistance / randomized controlled trials / meta-analysis

References

[1] MoghettiP. Insulin resistance and polycystic ovary syndrome. Curr Pharm Des, 2016, 22(36): 5526-5534

[2] XieJH, LiuQ, YangY. Correlation of liver enzymes with diabetes and pre-diabetes in middle-aged rural population in China. J Huazhong Univ Sci Technolog Med Sci, 2016, 36(1): 53-58

[3] ChenW, BallandE, CowleyMA. Hypothalamic insulin resistance in obesity: Effects on glucose homeostasis. Neuroendocrinology, 2017, 104(4): 364-381

[4] ZhaoY, HouL, GaoHJ, et al.. Independent relationship between body mass index and LH peak value of GnRH stimulation test in ICPP girls: A cross-sectional study. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(4): 556-562

[5] KellyT, YangW, ChenCS, et al.. Global burden of obesity in 2005 and projections to 2030. Int J Obes, 2008, 32(9): 1431-1437

[6] LazoM, ClarkJM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis, 2008, 28(4): 339-350

[7] FonsecaV, DesouzaC, AsnaniS, et al.. Nontraditional risk factors for cardiovascular disease in diabetes. Endocr Rev, 2004, 25(1): 153-175

[8] GoodarziMO, Bryer-AshM. Metformin revisited: reevaluation of its properties and role in the pharmacopoeia of modern antidiabetic agents. Diabetes Obes Metab, 2005, 7(6): 654-665

[9] XiaoWH, WangYR, HouWF, et al.. The effects of pioglitazone on biochemical markers of bone turnover in the patients with type 2 diabetes. Int J Endocrinol, 2013, 2013: 290734

[10] XuZ, LiR, ZhuC, et al.. Effect of acupuncture treatment for weight loss on gut flora in patients with simple obesity. Acupunct Med, 2013, 31(1): 116-117

[11] KumarR, MooventhanA, ManjunathNK. Immediate effect of needling at CV-12 (Zhongwan) acupuncture point on blood glucose level in patients with type 2 diabetes mellitus: A pilot randomized placebo-controlled trial. J Acupunct Meridian Stud, 2017, 10(4): 240-244

[12] HaoC, ZhangT, QiJ, et al.. Acupuncture at Zhibian (BL 54) through Shuidao (ST 28) for polycystic ovary syndrome. Zhongguo Zhen Jiu (Chinese), 2015, 35(5): 461-464

[13] FirouzjaeiA, LiGC, WangN, et al.. Comparative evaluation of the therapeutic effect of metformin monotherapy with metformin and acupuncture combined therapy on weight loss and insulin sensitivity in diabetic patients. Nutr Diabetes, 2016, 6: e209

[14] ZhengYH, WangXH, LaiMH, et al.. Effectiveness of abdominal acupuncture for patients with obesity-type polycystic ovary syndrome: A randomized controlled trial. J Altern Complem Med, 2013, 19(9): 740-745

[15] Garcia-VivasJM, Galaviz-HernandezC, Becerril-ChavezF, et al.. Acupoint catgut embedding therapy with moxibustion reduces the risk of diabetes in obese women. J Res Med Sci, 2014, 19(7): 610-616

[16] LiberatiA, AltmanDG, TetzlaffJ, et al.. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 2009, 62(10): e1-e34

[17] Song AQ, Liang FX. Is acupuncture effective for improving insulin resistance? A systematic review and meta-analysis. PROSPERO: CRD42018088172 https://doi.org/www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=88172

[18] HigginsJP, GreenS. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0: The Cochrane Collaboration, 2011

[19] ChenR, WangC, YanQY. Observation on therapeutic effect of polycystic ovary syndrome of damp-phlegm constitution treated with embedding therapy on backshu points and front-mu points combined with needlepricking therapy on Sifeng (EX-UE 10). Zhongguo Zhen Jiu (Chinese), 2014, 34(4): 355-358

[20] YangJ, LiuY, HuangJ, et al.. Acupuncture and Chinese medicine of artificial cycle therapy for insulin resistance of polycystic ovary syndrome with phlegm damp type and its mechanism. Zhongguo Zhen Jiu (Chinese), 2017, 37(11): 1163-1168

[21] CaiH, ZhaoLJ, ZhaoZM, et al.. Effect of acupuncture on serum leptin level in patients with type II diabetes mellitus. Zhen Ci Yan Jiu (Chinese), 2011, 36(4): 288-291

[22] LinRT, PaiHC, LeeYC, et al.. Electroacupuncture and rosiglitazone combined therapy as a means of treating insulin resistance and type 2 diabetes mellitus: A randomized controlled trial. Evid-based Compl Alt, 2013, 2013: 969824

[23] YangY, LiuYX. BO's abdominal acupuncture for obese type-2 diabetes mellitus. Zhongguo Zhen Jiu (Chinese), 2015, 35(4): 330-334

[24] LiQ, LiL, LuoYP, et al.. Effects of electroacupuncture on glycometabolism in metabolism syndrome. World J Acupunct Moxibustion, 2014, 24(3): 1-5