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Combined acupuncture, metformin therapy increases insulin sensitivity in diabetes

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May 4, 2016

Adults with type 2 diabetes and overweight or obesity randomly assigned 3 weeks of combined acupuncture and metformin lost weight and improved insulin sensitivity vs. those assigned metformin and a sham procedure, recent study findings show.

In a randomized, double blind, placebo-controlled study, Amir Firouzjaei, PhD, fellow in Chinese medicine at Nanjing University of Chinese Medicine, China, analyzed data from 39 adults with type 2 diabetes and BMI of at least 25 kg/m² prescribed metformin monotherapy. Researchers assigned patients electro-acupuncture and auricular acupuncture along with their metformin therapy (n = 19; mean age, 42 years; eight men) or to sham acupuncture treatments and metformin therapy (controls; n = 20; mean age, 41 years; eight men) 10 times every other day for 3 weeks. Researchers measured homeostasis model assessment for insulin resistance (HOMA-IR), fasting blood glucose, fasting insulin, lipid profile, adipokines and inflammatory markers.

Participants in the acupuncture group experienced reductions from baseline in both body weight (82.6 kg to 78.4 kg; P < .001) and BMI (27.6 kg/m² to 26.2 kg/m²; P < .001) at 3 weeks. Similarly, fasting blood glucose improved for those assigned acupuncture (6.65 mmol/L to 6.12 mmol/L), as did fasting insulin (14.47 µIU/mL to 9.91 µIU/mL), and HOMA-IR also fell in the acupuncture group (4.25 to 2.67; P < .001). No significant changes from baseline were found in the sham-procedure group.

Participants in the acupuncture group also saw reduced free fatty acids, plasma triglycerides, LDL cholesterol and an increase in HDL cholesterol, as well as reduced ceramide levels. Tumor necrosis factor-alpha, interleukin-6, glucagon-like peptide-1 and leptin levels all were reduced in the acupuncture group. No significant differences for C-reactive protein levels were found for either group, according to researchers.

“Our findings suggest that metformin and acupuncture combined therapy is more effective than metformin monotherapy on weight loss and improving insulin sensitivity among overweight/obese [type 2 diabetes] patients,” the researchers wrote. “[Electro-acupuncture] may be able to treat obesity through other different mechanisms as well, such as the suppression of inflammation and the improvement of lipid metabolism. In addition, [electro-acupuncture] may improve insulin sensitivity and [type 2 diabetes] through different mechanisms, such as weight loss, its anti-inflammatory effects, and the improvement of lipid metabolism and adipokines.” by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

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PERSPECTIVE
Philip Peplow

Philip Peplow

Metformin is used widely to treat type 2 diabetes. Metformin has effects beyond glycemic control, such as improvements in endothelial dysfunction, hemostasis, oxidative stress, insulin resistance, lipid profiles and fat redistribution, which may together contribute to decreased adverse cardiovascular outcomes. Metformin is associated with short-term weight loss, improvement of insulin sensitivity, and decreased visceral fat. A recent study by Liao and colleagues (Acupunct Med. 2015; doi:10.1136/acupmed-2014-010718) showed that combined treatment with metformin with electro-acupuncture resulted in a greater glucose-lowering effect, increased insulin sensitivity and decreased plasma free fatty acid levels than metformin alone. These same findings together with weight loss have been reported in the present article by Firouzjaei and colleagues using combined metformin and electro-acupuncture therapy over 3 weeks in obese human patients with type 2 diabetes. Obesity is associated with a low-grade inflammation and insulin resistance, and both metformin and acupuncture can act to increase insulin sensitivity. The serum adipokine profile was altered by the combined therapy with a decrease in the proinflammatory cytokines leptin, TNF-α and resistin and an increase in the anti-inflammatory cytokine adiponectin. These changes are consistent with a decrease in overall inflammatory state of the obese subjects. It would be pertinent to examine whether the weight loss can be maintained over a longer period with or without a continuation of the combined metformin-acupuncture therapy.


Philip Peplow, PhD
Research scientist
University of Otago
Dunedin, New Zealand

Disclosure: Peplow reports no relevant financial disclosures.