Objects: The purpose of this study is to investigate whether (1) acupuncture is effective in improving insulin resistance (IR) in patients with diabetes mellitus (DM) and (2) the effect of acupuncture varies depending on the type and dosage of acupuncture. Methods: PubMed, Embase, Web of Science, Cochrane Library, OpenGrey, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry were searched from their inception up to April 26, 2025. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the credibility of findings from each outcome. Systematic review and pairwise and exploratory network meta-analysis (NMA) of randomized controlled trials (RCTs) were conducted to investigate the effectiveness and safety of acupuncture on IR in patients with DM. Results: We included 16 RCTs from 2328 citations with 1087 participants. When compared with usual care, acupuncture had a significant effect on the homeostatic model assessment of IR (HOMA-IR; standardized mean difference SMD = -1.13, 95% confidence interval CI: -1.61 to -0.64), fasting blood sugar (FBS; SMD = -0.90, 95% CI: -1.45 to -0.35), and glycated hemoglobin (HbA1c; SMD = -0.66, 95% CI: -1.11 to -0.20) but not on 2-h blood glucose (2hBG; SMD = -1.32, 95% CI -2.83 to 0.19). When compared with sham acupuncture, acupuncture had a significant effect on FBS (SMD = -0.71, 95% CI: -1.18 to -0.25) but not on HbA1c (SMD = -0.14, 95% CI: -0.48 to 0.19). Subgroup analysis revealed that high-dose acupuncture had a more beneficial effect on HOMA-IR and 2hBG. According to the NMA, electroacupuncture (EA) might be the most promising acupuncture type for improving IR. However, we failed to analyze safety outcomes due to the inadequate data across the included studies. Conclusion: The findings suggested that acupuncture could be an effective therapy to improve IR in patients with diabetes. EA and high-dose acupuncture are two potential contributing factors.
Lyu et al. (Thu,) studied this question.