title: Comparative evaluation of the therapeutic effect of metformin monotherapy with metformin and acupuncture combined therapy on weight loss and insulin sensitivity in diabetic patients.
abstract: OBJECTIVE
  Obesity induces insulin resistance (IR), the key etiologic defect of type 2 diabetes mellitus (T2DM). Therefore, an incidence of obesity-induced diabetes is expected to decrease if obesity is controlled. Although Metformin is currently one of the main treatment options for T2DM in obese patients, resulting in an average of 5% weight loss, adequate weight control in all patients cannot be achieved with Metformin alone. Thus, additional therapies with a weight loss effect, such as acupuncture, may improve the effectiveness of Metformin.Subjective:We designed this randomized clinical trial (RCT) to compare the effects of Metformin monotherapy with that of Metformin and acupuncture combined therapy on weight loss and insulin sensitivity among overweight/obese T2DM patients, to understand whether acupuncture plus Metformin is a better approach than Metformin only on treating diabetes. To understand whether acupuncture can be an insulin sensitizer and, if so, its therapeutic mechanism.
  
  
  RESULTS
  Our results show that Metformin and acupuncture combined therapy significantly improves body weight, body mass index (BMI), fasting blood sugar (FBS), fasting insulin (FINS), homeostasis model assessment (HOMA) index, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), leptin, adiponectin, glucagon-like peptide-1 (GLP-1), resistin, serotonin, free fatty acids (FFAs), triglyceride (TG), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and ceramides.
  
  
  CONCLUSIONS
  Consequently, Metformin and acupuncture combined therapy is more effective than Metformin only, proving that acupuncture is an insulin sensitizer and is able to improve insulin sensitivity possibly by reducing body weight and inflammation, while improving lipid metabolism and adipokines. As a result, electro-acupuncture (EA) might be useful in controlling the ongoing epidemics in obesity and T2DM.
authors.affiliation: Key Laboratory of Acupuncture and Medicine Research of Minister of Education, The Second Clinical School, Nanjing University of Chinese Medicine, Nanjing, China.
authors.forename: A
authors.initials: A
authors.lastname: Firouzjaei
authors.affiliation: Epidemiology and Biostatistics Department, Nanjing University of Chinese Medicine, Nanjing, China.
authors.forename: G-C
authors.initials: GC
authors.lastname: Li
authors.affiliation: Key Laboratory of Acupuncture and Medicine Research of Minister of Education, The Second Clinical School, Nanjing University of Chinese Medicine, Nanjing, China.
authors.forename: N
authors.initials: N
authors.lastname: Wang
authors.affiliation: Key Laboratory of Acupuncture and Medicine Research of Minister of Education, The Second Clinical School, Nanjing University of Chinese Medicine, Nanjing, China.
authors.forename: W-X
authors.initials: WX
authors.lastname: Liu
authors.affiliation: Key Laboratory of Acupuncture and Medicine Research of Minister of Education, The Second Clinical School, Nanjing University of Chinese Medicine, Nanjing, China.
authors.forename: B-M
authors.initials: BM
authors.lastname: Zhu
mesh_terms: D015670:Acupuncture Therapy; D052242:Adiponectin / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D001835:Body Weight; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D009765:Obesity / Q000097:blood / Q000150:complications / Q000628:therapy; D052243:Resistin / Q000097:blood; D012701:Serotonin / Q000097:blood; D014280:Triglycerides / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D015850:Interleukin-6; D020738:Leptin; D052243:Resistin; D014280:Triglycerides; D014409:Tumor Necrosis Factor-alpha; D012701:Serotonin; D052216:Glucagon-Like Peptide 1; D008687:Metformin