Study: Metformin and acupuncture in overweight/obese patients with type 2 diabetes
Study: Metformin and acupuncture in overweight/obese patients with type 2 diabetes
Reference
a. Firouzjaei, GC Li, N. Wang, Wx Liu, BM ZHU. Comparative assessment of the therapeutic effect of metformin monotherapy with metformin and acupuncture combination therapy for weight loss and insulin sensitivity in diabetics. nutr-diabetes . 2016; 6: E209.
Design
randomized controlled study (RCT) to compare the therapeutic effects of metformin monotherapy with combination therapy from metformin and acupuncture on weight loss and insulin sensitivity
learning objectives
The therapeutic effects of metformin as monotherapy with metformin in combination with acupuncture should be compared to weight loss and insulin sensitivity in overweight/obese patients with type 2 diabetes mellitus
participant
This RCT comprised 39 participants who were distributed by an independent research assistant into a case group of 19 (8 men and 11 women) and a control group of 20 (8 men and 12 women).
In order to be included in the study, the participants had to be between 20 and 65 years old, overweight or obese [BODY MES INDEX (BMI) ≥25 kg/m 2 ] with type 2 diabetes (according to the diagnostic criteria set by the American Diabetes Association Type 2-diabetes) and metformin monotherapy in doses of 500 mg 1, 2 or 3 times a day.
patients if they have already received insulin therapy against type 2 diabetes; Had taken in the past 3 months of granting weight, antidepressants or hormonal medication; Or had one of the following diseases: nephrotic syndrome, edema, kidney failure, heart failure or an implanted pacemaker, liver dysfunction, proven by aspartTaMineOTRANSFERASE (AST) and glutamate pyruvattraninase level that are two times above the normal range, or diagnosis of cirrhosis, glycohemo global mirror above 9 %, endocrine diseases such as thyroid diseases or polycystic ovarian syndrome, disorders of homeostasis or other systemic diseases. Pregnant and breastfeeding mothers were also excluded.
methods
In the case group, the participants were treated in addition to metformin with electrical acupuncture with a frequency of 15 Hz/10 mA, combined with 8 needles (ST25, SP15, ST28, Ren 12; Ren 6). Other body and ear acupuncture points were also included. All participants were treated 10 times every other day over a period of 3 weeks. The control group was treated with "appearance" acupuncture and metformin.
target parameter
The researchers compared body weight, BMI, inflammatory marker, lipid profiles and obokines for overweight/obese patients with type 2 diabetes who received combination therapy with which metformin monotherapy received.
The effect of additional electrical acupuncture for metformin monotherapy was impressive.
important knowledge
body weight and bmi
In both groups, reductions were observed in both body weight and the BMI. However, only the case group had significant differences in the BMI (from 27.6 ± 2.5 before treatment to 26.2 ± 2.4 after treatment, p <0.001) and body weight (82.6 ± 6 kg before treatment up to 78.4 ± 6 kg after treatment, p <0.001).
Type 2-diabetes marker
A significant blood sugar-lowering activity was only determined in the case group, whereby the sober blood sugar from 6.65 ± 0.6 mmol/l before treatment sank to 6.12 ± 0.5 mmol/l ( p <0.001). Only in the case group there was a significant reduction in the insulin plasma level of 14.47 ± 0.8 μiu/ml before treatment to 9.91 ± 0.7 μiu/ml after treatment ( p <0.001). The authors found a "remarkable" difference in the sober insulin level between the case and the control group ( p <0.001). The homeostasis model (HOMO-IR) was only significantly changed in the case group (from 4.25 ± 0.2 before treatment to 2.67 ± 0.1 after treatment, p <0.001), and there were significant changes between the two groups in the HOMO index ( p <0.001).
With the exception of CRP, all blood sugar markers, lipid markers, inflammatory markers and obokine showed positive changes when electrical acupuncture was also applied to metformin. The authors suggest that electrical acupuncture can be viewed as a new insulin sensitizer.
lipid profiles
The mirrors of free fatty acids were reduced in both groups, with significant reductions only in the case group. In the case group, the triglycerides decreased significantly (from 2.59 ± 0.6 mmol/l before treatment to 2.24 ± 0.6 mmol/l after treatment, p <0.001); Low-density-lipoprotein cholesterol (LDL-C) sank significantly (from 4.05 ± 0.5 mmol/l before treatment to 3.68 ± 0.5 mmol/l after treatment, p <0.001); and high-density lipoprotein cholesterol (HDL-C) rose significantly (1.08 ± 0.1 mmol/l before treatment to 1.29 ± 0.1 mmol/l after treatment), p <0.001). Ceramide levels were only significantly reduced in the case group (8.06 ± 0.2 g/dl before treatment to 6.06 ± 0.3 g/dl after treatment, p <0.001).
inflammatory marker
The values of the tumor necrosis factor (TNF) alpha were reduced in both groups, with significant reductions only in the case group (from 1.44 ± 0.2 pg/ml before treatment to 1.41 ± 0.5 pg/ml after treatment, p <0.001). The interleukin-6 levels were reduced in both groups, with a significant reduction only in the case group (from 1.44 ± 0.3 pg/ml before treatment to 1.09 ± 0.5 pg/ml after treatment, p <0.001). The C-reactive protein (CRP) was not significantly reduced in both groups.
adipokine
The leptin levels decreased in both groups, whereby significant reductions were only observed in the case group (from 13.32 ± 0.2 ng/ml before treatment to 10.84 ± 0.4 ng/ml after treatment). p <0.001). In the "noticeable" case group, the obonecin levels were increased (7.47 ± 0.2 μ g/ml before treatment to 8.73 ± 0.2 μ g/ml after treatment, p <0.001) and significantly different from the control group. Glukagon-like peptide-1 was also only significantly reduced in the case group (3.77 ± 0.2 mmol/l before treatment to 3.21 ± 0.1 mmol/l after treatment, p <0.001). The resistant levels were only significantly reduced in the case group (from 7.43 ± 0.2 ng/ml before treatment to 5.24 ± 0.3 ng/ml after treatment, p <0.001). Finally, the serotonin levels were only significantly increased in the case group (from 130 ± 3 ng/ml before treatment to 170 ± 3 ng/ml after treatment, p <0.001).
practice implications
This study is a strong argument for the addition of electro acupuncture for obese and overweight people in whom type 2 diabetes was diagnosed and who receive first-line therapy with metformin. It shows that the combined electrical acupuncture metformin therapy is effective in promoting weight loss and reducing the BMI and at the same time significant positive changes in inflammatory markers, obokines and lipid markers cause all comorbid factors in the treatment and reversal of type 2 diabetes.
The results of this study show improvements in all measured parameters both in case and in the control group, but the results were only significant in the case group, with the exception of CRP, where no changes were observed.
The effect of additional electrical acupuncture for metformin monotherapy was impressive. In the case group, an average weight loss of 9 lb over a period of 3 weeks was observed, compared to an average weight loss of 3 LB in the control group, with a corresponding change in the BMI of 1.4 kg/m 2 Acceptance in the case group compared to 0.5 kg/m in the control group. Since overweight or obesity is a significant risk factor for the development of type 2 diabetes and it has proven that weight loss is a significant factor in control and reversal, these study results are already encouraging.
This study provides new insights into the effectiveness of electrical acupuncture to several biochemical mechanisms, including lipid metabolism, cytokin function, inflammation and obocin production. These mechanisms are hardly understood, but according to the study authors, the reduction of hunger, fat and carbohydrate metabolism, glucose inhibited neurons and the feeding behavior can include.
When electrical acupuncture in people in whom type 2 diabetes has been diagnosed and the metformin is as effective as this study determines, one wonders how effective treatment can be in humans who are overweight, obese or otherwise a high risk of developing type 2 diabetes.
restrictions
This study is a pilot study with a total of only 39 participants. Larger studies are required to finally determine the role of electrical acupuncture in combination with metformin in overweight/obese patients with type 2 diabetes. In addition, this course of treatment was relatively short and the frequency of treatment was shortened by normal clinical treatment protocols, which makes it difficult to take into account placebo effects that could have played a role. However, the low risk of therapy and the dramatic results that this study suggests can easily be integrated into the treatment of our patients with type 2 diabetes that are currently taking metformin.