Changes in HbA_1c and circulating and adipose tissue androgen levels in overweight‐obese women with polycystic ovary syndrome in response to electroacupuncture

Abstract

SummaryAimInsulin sensitivity is ~40% lower in women with polycystic ovary syndrome (PCOS) than in controls. We tested the hypothesis that 5 weeks of electroacupuncture treatment improves glucose regulation and androgen levels in overweight/obese women with PCOS.Material and MethodsSeventeen women with PCOS, aged 18 to 38 years, with a body mass index (BMI) ≥25 kg/m2 and diagnosed with PCOS were included in this experimental and feasibility study and subjected to five weeks of electroacupuncture treatments three times/week. The primary outcome was changes in whole‐body glucose homeostasis measured by euglycemic hyperinsulinemic clamp before and after the intervention. Secondary outcome were changes in HbA1c, circulating catecholamines, adipocyte size and adipose tissue expression of sex steroids and nerve growth factor (NGF).ResultsNo significant change in glucose homeostasis was observed, but HbA1c decreased by 9.5% (p = 0.004), circulating testosterone decreased by 22% (p = 0.0007) and dihydrotestosterone decreased by 12% (p = 0.007). The two vagal activity markers of plasma serotonin levels and the dopamine metabolite homovanillic acid decreased by 21% (p = 0.027) and 20% (p = 0.011), respectively. Adipose tissue concentrations of testosterone decreased by 18% (p = 0.049), and androstenedione decreased by 13% (p = 0.035), and mature NGF/proNGF ratio, a marker of sympathetic activity, increased (p = 0.04). These changes occurred without changes in anthropometrics.ConclusionFive weeks of electroacupuncture treatment improves HbA1c and circulating and adipose tissue androgens in women with PCOS. This effect is mediated, at least in part, via modulation of vagal activity and adipose tissue sympathetic activity. Based on these findings, we have recently initiated a randomized controlled study (NTC02647827).

Autonomic nervous system activation mediates the increase in whole‐body glucose uptake in response to electroacupuncture

“…It has been reported that proNGF acts as an inducer of sympathetic denervation in peripheral tissues (37,38). Our data are consistent with a possible increased conversion of proNGF into mNGF (39), which would support sympathetic activity far beyond the stimulation period with possible long-lasting beneficial effects on adipose tissue metabolism (36,40) and glucose uptake (26). Serotonin affects glucose homeostasis and insulin resistance via vagal afferent serotonergic neurons and receptors in peripheral tissue.…”

“…We used a Western style of acupuncture (26). In brief, acupuncture needles were placed bilaterally in the abdominal muscle, in the quadriceps muscles, and in the muscles below the medial side of the knee, all in somatic segments corresponding to the innervation of the ovaries and pancreas.…”

The influence of polycystic ovarian syndrome on in vitro fertilization

“…Additionally, hyperandrogenism is related to the high sympathetic nerve activity in women with the syndrome and the activity of these nerves increasing the response to hyperinsulinemia. 8 The reduction in fertility rates with an increase in free androgen content (ITA), obtained from total testosterone x 100/SHBG calculation in women who have insulin resistance adds to the evidence that insulin resistance increases hyperinsulinemia and vice versa. This may indicate that these factors negatively affect the ovaries and consequently diminish fertility.…”

Point of Influence: What is the Role of Acupuncture inIn VitroFertilization Outcomes?

“…12,14 In polycystic ovary syndrome, acupuncture could affect glucose uptake in the skeletal tissue, 15,16 might decrease hyperinsulinemia, and might increase insulin clearance. 17 The aim of this article is to provide an overview of the current literature evaluating acupuncture's effects on IVF outcomes.…”