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Metformin provides greater improvement in HOMA-IR than acupuncture in PCOS, with electroacupuncture leading among acupuncture techniques.
Metformin is more effective than acupuncture in improving insulin resistance in women with polycystic ovary syndrome (PCOS), while acupuncture—particularly electroacupuncture—appears to have a greater impact on lowering fasting blood glucose, according to a new systematic review and network meta-analysis.
Yun Wang and other researchers conducted a comprehensive literature search using databases such as PubMed, EMBASE, the Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP. Only randomized controlled trials (RCTs) exploring acupuncture’s impact on PCOS-related insulin resistance were incorporated. Notably, 2 independent reviewers screened studies, extracted data, and evaluated quality with the help of the Cochrane bias risk tool. Data analysis was carried out via Stata 17.
The primary outcome was homeostasis model assessment of insulin resistance (HOMA-IR). The secondary outcome measures included fasting blood glucose, fasting insulin, body mass index (BMI), and waist-to-hip ratio. In total, 11 RCTs involving 1,248 PCOS-affected women were analyzed. As found, reductions in HOMA-IR and fasting insulin were smaller with acupuncture when compared to metformin. However, acupuncture led to greater, though statistically insignificant, reductions in BMI, waist-to-hip ratio, and fasting plasma glucose, as shown in Table 1:
Subgroup analysis with placebo controls showed that metformin + sham acupuncture markedly outperformed acupuncture + placebo in reducing HOMA-IR [SMD = 0.49, 95% CI (0.02, 0.96)]. Conversely, acupuncture + placebo demonstrated a significant advantage in lowering fasting plasma glucose [SMD = -0.38, 95% CI (-0.57, -0.19)]. Network meta-analysis revealed that only electroacupuncture [SMD = -0.27, 95% CI (-1.37, 0.83)] and abdominal acupuncture [SMD = -0.13, 95% CI (-1.19, 0.94)] showed notable effects on reducing HOMA-IR compared with metformin, though these differences were not statistically significant.
Surface under the cumulative ranking curve (SUCRA) values ranked electroacupuncture as the most valuable modality for improving HOMA-IR in insulin-resistant women with PCOS (67.4%), followed by abdominal acupuncture (58%). Hence, metformin remains superior for improving insulin resistance in PCOS, while acupuncture—particularly electroacupuncture—may offer better control of fasting glucose. They caution, however, that due to limitations in current evidence, larger high-quality multicenter RCTs are needed to confirm these findings.
Frontiers in Endocrinology
Comparative effects of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome: a systematic review and meta-analysis
Yun Wang et al.
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