Cao Jie, Nie GuanHua, Dai Zhihao, Shan Dan, Wei Zhihong
Department of Obstetrics and Gynecology, Jiangsu University Affiliated Peoples Hospital, Zhenjiang, China.
Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China.
Front Med (Lausanne). 2023 Dec 14;10:1232127. doi: 10.3389/fmed.2023.1232127. eCollection 2023.
This study explored the efficacy of acupuncture and metformin in enhancing insulin sensitivity among women with polycystic ovary syndrome (PCOS) and insulin resistance (IR), distinguishing between overweight/obese and lean groups.
A post-hoc analysis of a randomized trial (NCT02491333) was undertaken. Participants were women aged 18-40 with PCOS and IR. They were randomized to receive true acupuncture with a placebo, metformin with sham acupuncture, or sham acupuncture with a placebo for 4 months, with follow-up visits over 3 months. Our study, involving 339 women, assessed the differential impact of acupuncture and metformin on insulin sensitivity in overweight/obese [body mass index (BMI) ≥ 24] versus lean women (BMI < 24). Primary outcomes measured changes in the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) at 4 and 7 months. Secondary outcomes assessed changes in glucose area under the curve (glucose) during the oral glucose tolerance test (OGTT) and BMI changes at 4 months.
Overweight/obese participants were generally older with higher measurements in various health metrics, but lower levels in specific hormonal metrics compared to lean women ( < 0.05). Among overweight/obese women, metformin outperformed acupuncture in reducing HOMA-IR levels ( = 0.004) and showed a significant drop from the baseline after 4 months ( < 0.05). In contrast, acupuncture's effect on HOMA-IR did not significantly differ from sham acupuncture at 4 and 7 months. For lean women, metformin and acupuncture showed comparable improvements in HOMA-IR, with notable declines at 4 and 7 months ( < 0.05). Acupuncture proved more beneficial for lean women than their overweight/obese counterparts after 4 months ( = 0.021).
In overweight/obese women with PCOS and IR, acupuncture was less effective than metformin in enhancing insulin sensitivity. However, in lean women, acupuncture's efficacy was comparable to metformin. Further studies are required to validate these observations.
本研究探讨针刺与二甲双胍对多囊卵巢综合征（PCOS）合并胰岛素抵抗（IR）女性胰岛素敏感性的增强作用，并区分超重/肥胖组与体重正常组。
对一项随机试验（NCT02491333）进行事后分析。参与者为年龄在18 - 40岁的PCOS合并IR女性。她们被随机分为三组，分别接受真针刺加安慰剂、二甲双胍加假针刺、假针刺加安慰剂治疗4个月，并随访3个月。我们的研究纳入了339名女性，评估针刺和二甲双胍对超重/肥胖[体重指数（BMI）≥24]女性与体重正常（BMI < 24）女性胰岛素敏感性的不同影响。主要结局指标为4个月和7个月时胰岛素抵抗稳态模型评估（HOMA - IR）的变化。次要结局指标评估口服葡萄糖耐量试验（OGTT）期间曲线下葡萄糖面积（血糖）的变化以及4个月时BMI的变化。
与体重正常女性相比，超重/肥胖参与者年龄普遍较大，各项健康指标测量值较高，但特定激素指标水平较低（< 0.05）。在超重/肥胖女性中，二甲双胍在降低HOMA - IR水平方面优于针刺（= 0.004），且4个月后与基线相比有显著下降（< 0.05）。相比之下，针刺在4个月和7个月时对HOMA - IR的影响与假针刺无显著差异。对于体重正常女性，二甲双胍和针刺在改善HOMA - IR方面效果相当，4个月和7个月时均有显著下降（< 0.05）。4个月后，针刺对体重正常女性的益处大于超重/肥胖女性（= 0.021）。
在超重/肥胖的PCOS合并IR女性中，针刺在增强胰岛素敏感性方面不如二甲双胍有效。然而，在体重正常女性中，针刺的疗效与二甲双胍相当。需要进一步研究来验证这些观察结果。
