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

ObjectiveTo perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate acupunctures clinical effect of on insulin resistance (IR) in women with polycystic ovary syndrome (PCOS). MethodsPubMed, 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. ResultsOur 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). ConclusionAlthough 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.