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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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] = \u22121.13, 95% confidence interval [CI]: \u22121.61 to \u22120.64), fasting blood sugar (FBS; SMD = \u22120.90, 95% CI: \u22121.45 to \u22120.35), and glycated hemoglobin (HbA1c; SMD = \u22120.66, 95% CI: \u22121.11 to \u22120.20) but not on 2-h blood glucose (2hBG; SMD = \u22121.32, 95% CI \u22122.83 to 0.19). When compared with sham acupuncture, acupuncture had a significant effect on FBS (SMD = \u22120.71, 95% CI: \u22121.18 to \u22120.25) but not on HbA1c (SMD = \u22120.14, 95% CI: \u22120.48 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27683605251397779","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T01:56:27Z","timestamp":1765158987000},"page":"500-509","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Effect and Contributing Factors of Acupuncture for Insulin Resistance in Diabetes Mellitus: A Systematic Review and Pairwise and Exploratory Network Meta-Analysis"],"prefix":"10.1177","volume":"32","author":[{"given":"Tianyi","family":"Lyu","sequence":"first","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Pulmonary Disease, China-Japan Friendship Hospital, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusheng","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Pulmonary Disease, China-Japan Friendship Hospital, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youxian","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Graduate Studies, Henan University of Traditional Chinese Medicine, Henan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Zhang","sequence":"additional","affiliation":[{"name":"Dean\u2019s Office, Lhasa Municipal People\u2019s Hospital, Xizang, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2024.06.029"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cvsm.2023.01.006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00877-z"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad450"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00769-4"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26031094"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-022-01073-0"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.747065"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2174\/1381612826666200728144200"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2024.108941"},{"issue":"10","key":"e_1_3_2_12_2","first-page":"741","article-title":"Effects of acupuncture on mood and glucose metabolism in the patient of type 2 diabetes","volume":"27","author":"Shen PF","year":"2007","unstructured":"Shen PF, , Kong L. 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