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Polycystic Ovary SyndromePhase 2PIAIINCT02647827

Acupuncture or Metformin for Insulin Resistance in Women With PCOS

A Phase 2 study testing Lifestyle management, Acupuncture and Metformin in people with Polycystic Ovary Syndrome and Insulin Resistance, run by Karolinska Institutet at 2 sites in 2 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The hypothesis is that acupuncture is equally effective as metformin (both treatments combined with lifestyle management) in improving whole body glucose homeostasis in insulin resistant women with polycystic ovary syndrome (PCOS), and that both are superior to lifestyle management alone. Read more about this study

Who is it for?
Ages 18 to 40 years, women onlyHealthy volunteers can take part
What is being tested?
Lifestyle management, Acupuncture and Metformin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
303 participants
Where
2 sitesin 2 countries
Study dates
Dec 2015to Jun 2026
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 40 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Age 18 to 40 years
  • Body mass index (BMI) ≥25 to ≤40 given that 95% of all women with PCOS with a BMI ≥25 are insulin resistant (71,72).
  • PCOS diagnosis according to Rotterdam criteria 2003 (73), with at least two of the following three symptoms: Clinical signs of hyperandrogenism (hirsutism or acne); oligo/amenorrhea; and/or polycystic ovaries (PCOS). Hirsutism is defined as a self-reported Ferriman-Gallwey (FG) score ≥8 (≥5 Asian) (74,75). Acne is defined by a positive response to the question Do you have acne? Oligomenorrhea is defined as an intermenstrual interval >35 days and <8 menstrual bleedings in the past year. Amenorrhea as <3 cycles per year. PCO is defined by transvaginal ultrasound with ≥12 follicles 2-9 mm and/or ovarian volume ≥10 ml in one or both ovaries.
  • Willing to sign the consent form.
  • Controls should have BMI >25 to <40, regular cycles with 28 days ± 2 days, and no signs of hyperandrogenism. They are excluded if they have menstrual irregularities, signs of hyperandrogenism (FG >4), or evidence of PCO morphology on ultrasound.

Who cannot join

  • Age >40
  • Exclusion of other endocrine disorders such as non-classic congenital adrenal hyperplasia (17-hydroxyprogesterone < 3nmol/L), androgen secreting tumors or suspected Cushing's syndrome.
  • Having known renal disease (creatinine clearance < 60 mL/min), hepatic insufficiency, autoimmune disorders or cancer.
  • Any acute condition with potential to alter renal function or cause tissue hypoxia.
  • Type I diabetes.
  • Pharmacological treatment (cortizon, antidepressant, other antidiabetic treatment such as insulin and acarbose, hormonal contraceptives, hormonal ovulation induction or other drugs judged by discretion of investigator) within 12 weeks. Depo Provera or similar within 6 months.
Show all 13Show fewer
  • Hypersensitivity to metformin hydrochloride or to any of the excipients.
  • Blood pressure >160 / 100 mmHg
  • Pregnancy or breastfeeding the last 6 months
  • Acupuncture the last 2 months
  • Daily smoking and alcoholic intake
  • Language barrier or disabled person with reduced ability to understand the information given.
  • In total 50 controls will be matched at baseline (age, weight and BMI) to women with PCOS. Controls will undergo screening and baseline visit, but will not be randomized to any treatment.

Trial locations and contacts

2 sites in 2 countries.

Elisabet Stener-Victorin, PhD contact

+46705643655

elisabet.stener-victorin@ki.se

Berit Legerstam, Study nurse contact

+46851773782

berit.legerstam@karolinska.se

2 sites in 2 countries

China1 site, 1 recruiting
  • Peking University

    Beijing, 100871

    Jie Qiao, Professor, +8615611908108, jie.qiao@263.net

    Haolin Zhang, PhD, +8613911533466, zoe@bjmu.edu.cn

    Recruiting

Other trials in China

Sweden1 site, 1 recruiting
  • Karolinska University Hospital

    Stockholm, 17176

    Liselott Blomberg, Study nurse, +46851773782, liselott.blomberg@regionstockholm.se

    Anna Cockin, Study nurse, +46851773782, anna.cockin@regionstockholm.se

    Recruiting

Other trials in Sweden

About this study

Official title: Acupuncture or Metformin for Insulin Resistance in Women With Polycystic Ovary Syndrome: A Randomized Controlled Trial

The hypothesis is that acupuncture is equally effective as metformin (both treatments combined with lifestyle management) in improving whole body glucose homeostasis in insulin resistant women with polycystic ovary syndrome (PCOS), and that both are superior to lifestyle management alone. The investigators hypothesize that acupuncture and metformin induce ovulation and improve hyperandrogenism, as well as health related quality of life (HRQoL) and symptoms of anxiety and depression. Although equally effective (acupuncture and metformin), the investigators hypothesize that acupuncture is associated with less negative side-effects. The investigators also hypothesize that these treatments have the potential to restore epigenetic and molecular alterations in target tissues (endometrial-, adipose-, and skeletal muscle tissue) and thus have the potential to prevent the development of type 2 diabetes (T2D).

Read the detailed description

Specific Aims The purpose of the study is to perform a randomized controlled trial of women with PCOS, comparing the effectiveness of lifestyle management alone, and in combination with acupuncture or metformin treatment on whole body glucose homeostasis, with the ultimate goal to prevent the development of type 2 diabetes.

Primary aim

  1. To determine the clinical effectiveness of 4 months of 1) electroacupuncture + lifestyle management and 2) metformin + lifestyle management, compared to 3) lifestyle management only, for improvement of insulin sensitivity as measured by HOMA-IR, by the insulin response to glucose assessed by calculating the area under the curve (AUCinsulin) during the oral glucose tolerance test (OGTT), and by glucose regulation (assessed by analyzing Hba1c levels).

Secondary aims

  1. To evaluate changes in secondary metabolic measures, including fasting insulin, c-peptide, glucose, and adipokines, calculation of HOMA-B (i.e. the Islet β-cell function) and the c-peptide index, assessment of the adipokines and lipid profile, body size and proportions and body fat distribution.
  2. To determine changes in genome-wide gene expression and DNA methylation profiles related to insulin sensitivity in fat, muscle and endometrial tissue biopsies, and biomarkers in whole blood.
  3. To evaluate endocrine measures including menstrual pattern and ovulation frequency, circulating hormones (sex steroids, AMH, gonadotropins), and excretion of metabolites of sex steroids in urine.
  4. To determine changes in women's HRQoL, symptoms of anxiety and depression, dieting and eating patterns, and negative side-effects.
  5. To evaluate the cost-effectiveness of the different treatments.
Being tested
Lifestyle management, Acupuncture, Metformin
Keywords
Acupuncture, Metformin, Glucose metabolism, Hba1c
Medical subject headings
Polycystic Ovary Syndrome, Insulin Resistance, Hyperandrogenism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Lifestyle managementOther

    All women will receive lifestyle management instructions at the baseline visit, before randomization. The lifestyle management involves one initial counselling session in connection with the baseline visit, which includes information about the importance of weight management, healthy diet and physical activity.

  • AcupunctureDevice

    Disposable, single-use, sterilized CE marked needles made of stainless steel, 0.25 x 30 mm and 0.30 x 40/50 mm will be inserted to a depth of 15-40 mm in segmental acupuncture points located in abdominal and leg muscles, with innervations corresponding to the ovaries and the pancreas. Two sets of acupuncture points will be alternated every second treatment.

  • MetforminDrug

    Oral metformin 500 mg three times daily, in total 1500 mg per day. To reduce gastrointestinal side-effects of metformin, the dose will be slowly escalated starting with 500 mg daily during the first week, increasing to 500 mg twice per day during the second the week, and 500 mg three times daily, morning, lunch and dinner from the third week in total 16 weeks including the 3 weeks step-up phase (i.e. 4 months).

Study groups in NCT02647827
Study groupRoleWhat they receive
Lifestyle managementActive comparatorAll women will receive lifestyle management instructions at the baseline visit, before randomization.
Receives: Other: Lifestyle management
Acupuncture + lifestyle managementActive comparatorThree treatment per week (4 weeks) and thereafter 2 times per week during 12 weeks.
Receives: Other: Lifestyle management; Device: Acupuncture
Metformin + lifestyle managementActive comparatorOral metformin 500 mg three times daily, in total 1500 mg per day.
Receives: Other: Lifestyle management; Drug: Metformin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes from baseline to after 4 months in HOMA-IR [fasting insulin (μU/mL) × fasting glucose (mmol/L)] / 22.5)

    Changes from baseline to after 4 months of treatment in HOMA-IR [fasting insulin (μU/mL) × fasting glucose (mmol/L)] / 22.5) between 1) acupuncture + lifestyle management and 2) metformin + lifestyle management compared to 3) lifestyle management only.

    Measured: 4 months

  2. Changes from baseline to after 4 months of treatment in HbA1c

    Changes from baseline to after 4 months of treatment in HbA1c between 1) acupuncture + lifestyle management and 2) metformin + lifestyle management compared to 3) lifestyle management only.

    Measured: 4 months

  3. Changes from baseline to after 4 months of treatment in insulin response to glucose during the oral glucose tolerance test (OGTT)

    Changes from baseline to after 4 months of treatment in insulin response to glucose during the OGTT (AUC using the trapezoidal rule) between 1) acupuncture + lifestyle management and 2) metformin + lifestyle management compared to 3) lifestyle management only.

    Measured: 4 months

Secondary outcomes (8)
  1. Changes from baseline to after 4 months and again 4 months after last treatment in secondary metabolic measures

    Changes in secondary metabolic measures with calculation of e.g. HOMA-B

    Measured: 8 months

  2. Changes from baseline to after 4 months and again 4 months after last treatment gene expression and DNA methylation profiles related to insulin sensitivity in fat, muscle and endometrial tissue biopsies, and biomarkers in whole blood.

    Changes in mRNA gene expression and DNA methylation expression and biomarkers in whole blood.

    Measured: 8 months

  3. Changes from baseline to after 4 months and again 4 months after last treatment in menstrual pattern.

    Changes in menstrual pattern per month.

    Measured: 8 months

  4. Changes from baseline to after 4 months and again 4 months after last treatment in circulating reproductive hormones.

    Changes in circulating circulating reproductive hormones.

    Measured: 8 months

  5. Changes from baseline to after 4 months and again 4 months after last treatment in women's HRQoL.

    Changes in women's HRQoL measured with polycystic ovary syndrome questionnaire (PCOSQ) and short form-36 (SF36) two validated questionnairs.

    Measured: 8 months

  6. Changes from baseline to after 4 months and again 4 months after last treatment in women's symptoms of anxiety and depression.

    Changes in women's symptoms of anxiety and depression measured with the self-reported version of the Comprehensive Psychopathological Rating Scale for Affective Syndromes (CPRS-S-A).

    Measured: 8 months

  7. Changes from baseline to after 4 months and again 4 months after last treatment in women's dieting and eating patterns.

    Changes in women's dieting and eating patterns assessed with Three-Factor Eating Questionnaire (TFEQ-R21), and Questionnaire of Eating and Weight Patterns-Revised (QEWP-R).

    Measured: 8 months

  8. Cost-effectiveness of the different treatments throughout the study.

    Cost-effectiveness of the different treatments by calculation of e.g. treatment visits, time for patient and with EuroQol-5 dimension (EQ-5D).

    Measured: 8 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Jan 2016 (estimated)
  2. Study startDec 2015
  3. Primary completionJun 2025 (estimated)
  4. Study completionJun 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
303 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02647827
Sponsor's protocol ID
EudraCT: 2015-004250-18
Other IDs
2015-004250-18, 2015
Acronym
PIAII
Status last verified
Oct 2024
First submitted
23 Dec 2015
Last updated
9 Oct 2024
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided

Publications

  • Stener-Victorin E, Zhang H, Li R, Friden C, Li D, Wang W, Wang H, Chang C, Li S, Huo Z, Zhang H, Ji X, Linden-Hirschberg A, Qiao J. Acupuncture or metformin to improve insulin resistance in women with polycystic ovary syndrome: study protocol of a combined multinational cross sectional case-control study and a randomised controlled trial. BMJ Open. 2019 Jan 4;9(1):e024733. doi: 10.1136/bmjopen-2018-024733.

    PubMed 30612112

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Lifestyle management, Acupuncture and Metformin in people with Polycystic Ovary Syndrome and Insulin Resistance, run by Karolinska Institutet at 2 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 9 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in China, Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Elisabet Stener-Victorin, PhD (+46705643655, elisabet.stener-victorin@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes from baseline to after 4 months in HOMA-IR [fasting insulin (μU/mL) × fasting glucose (mmol/L)] / 22.5) (time frame: 4 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02647827, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Oct 2024.

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