Effectiveness of acupuncture and moxibustion therapy on glycolipid metabolism in patients with obese-type polycystic ovarian syndrome: A systematic review and network meta-analysis

BACKGROUND: The efficacy of acupuncture and moxibustion-related therapy (AMRT) on the glycolipid metabolism in patients with polycystic ovarian syndrome (PCOS), especially those with an obese phenotype, is still uncertain. This paper aims to analyze the impact of AMRT on glycolipid metabolism in managing obese-type PCOS. METHODS: This systematic review and meta-analysis synthesized evidence from randomized controlled trials on AMRT, compared to conventional western medicine or blank control for obese PCOS focusing on their glycolipid metabolism, searched across 7 databases. Direct and Indirect Meta-analysis was conducted using Review Manager 5.4 and R program, presenting continuous data as mean differences (MD) with 95% confidence intervals (CIs). The Cochrane risk-of-bias tool for trials 2 (ROB2) was used for methodological quality assessment, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach evaluated the certainty of evidence. RESULTS: Thirty randomized controlled trials were included. Compared to control treatments, AMRT significantly improved fasting plasma glucose (FPG) (MD = -0.19, 95% CI = -0.28 to -0.09, moderate certainty), Weight (W) (MD = -2.34, 95% CI = -4.51 to -0.17, moderate certainty) and triglycerides (TG) (MD = -0.35, 95% CI = -0.40 to -0.29, moderate certainty), and showed similar benefits for low-density lipoprotein (MD = -0.20, 95% CI = -0.40 to -0.01, moderate certainty) and total cholesterol (MD = -0.36, 95% CI = -0.49 to -0.23, moderate certainty). The other indicators were deemed unreliable or showed negative results. During network meta-analysis, Moxibustion combined with catgut embedding was the most effective measure in the improvement of FPG, fasting insulin (FIN) and insulin resistance (IR). Manual acupuncture combined with metformin ranked third improving BMI, TG and IR, while ranked first in waist-hip ratio (WHR). No statistical incoherence in all comparisons of direct with indirect evidence for efficacy and treatment discontinuation. CONCLUSION: Acupuncture and related therapies can effectively improve glycolipid metabolism (FPG, W, total cholesterol, TG, low-density lipoprotein) in obese PCOS patients (moderate certainty evidence) and have a comparable effect to conventional medicine on improving IR (moderate certainty evidence). Among them, moxibustion plus catgut embedding was the most optimal AMRT on reducing blood glucose, while manual acupuncture combined with metformin was the best AMRT applying on ameliorating blood lipids.