Acupuncture, promising adjuvant therapy for improving insulin resistance in women with PCOS

Besides, it is safer than other treatments with fewer adverse effects and could be an adjuvant strategy for improving PCOS-insulin resistance (PCOS-IR).

Polycystic ovary syndrome is a complex metabolic and endocrine disorder characterized by androgen excess and ovarian dysfunction. Its pathogenesis remains unclear till now. However, insulin resistance is considered the primary pathological basis for the reproductive dysfunction linked with PCOS.

Metformin is often recommended to adolescents or adult women with PCOS or women with BMI (body mass index) > 25 kg/m2 for managing metabolic disorders and weight. Some studies have reported that reducing hyperinsulinemia and improving IR can reduce concentrations of systemic androgen and improve some PCOS characteristics. However, there is no clarity on the mechanism underlying metformin's effects on PCOS-IR, and it causes adverse effects, specifically nausea and diarrhoea, in about 25% of patients. Metformin has limitations related to patient compliance and negative effects. Therefore, there arises a need for easily administered and inexpensive treatment with lesser adverse effects.

Some studies have shown the beneficial effect of acupuncture on IR with fewer adverse events. A recent meta-analysis also reported that t acupuncture could improve insulin sensitivity and glucose metabolism in PCOS patients. However, a meta-analysis has yet to be performed to evaluate acupuncture's safety and effectiveness for PCOS-IR. Considering this, Yu Liu and colleagues from China conducted a meta-analysis and systematic review of RCTs to clarify the clinical effect of acupuncture on IR in women with PCOS and provide medical evidence for clinical application.

For this purpose, the researchers searched the online databases from inception to December 20, 2021. The analysis included 17 eligible RCTs consisting of 1511 participants. It included RCTs in which acupuncture had been examined as the sole or adjunctive PCOS-IR treatment. The primary endpoint was the HOMA-IR (homeostasis model assessment of insulin resistance). Secondary outcomes included BMI, fasting insulin (FINS), fasting blood glucose (FBG), and adverse events.

Following were the study's key findings:

· Compared with other treatments, acupuncture therapy yielded a more significant mean reduction in HOMA-IR (MD = −0.15) and BMI (MD = −1.47).

· Acupuncture was associated with a lower risk of adverse events than other treatments (RR, 0.15).

· Additionally, the combination treatment of acupuncture and medicine is more effective in improving HOMA-IR (MD = −0.91), FBG (MD = −0.30), FINS (MD = −2.33) and BMI (MD = −1.63) than medicine alone.

"Our findings showed that in individuals with PCOS-IR, acupuncture can significantly improve BMI and HOMA-IR and has fewer side effects than other treatments," the researchers wrote. "The combination treatment of acupuncture and medicine more effectively improves FBG, HOMA-IR, BMI, and FBG than medicine alone."

To conclude, acupuncture may be an effective adjuvant strategy for PCOS-IR improvement. However, there are some limitations related to both methodology and sample size. Therefore further large-scale, long-term RCTs with strict methodological standards are needed.

Reference:

Liu Y, Fan HY, Hu JQ, Wu TY, Chen J. Effectiveness and safety of acupuncture for insulin resistance in women with polycystic ovary syndrome: A systematic review and meta-analysis. Heliyon. 2023 Feb 26;9(3):e13991. doi: 10.1016/j.heliyon.2023.e13991. PMID: 36923858; PMCID: PMC10009463.