Background: and purpose Acupuncture has gained increasing attention in the treatment of insulin resistance (IR). This study systematically reviews the efficacy of acupuncture on clinical IR outcomes. Methods: Cochrane Central Register of Controlled Trials, Embase, Medline (via OVID), China National Knowledge Infrastructure (CNKI), Wan Fang and China Science and Technology Journal Database (VIP) were searched to collect randomized controlled trials (RCTs) of patients with IR treated by acupuncture. Meta-analysis was performed by RevMan 5.3. Results: With acupuncture, the homeostasis model assessment of insulin resistance (homa-IR) significantly decreased (mean difference (MD) = -1.04, 95% confidence interval (CI) −1.37 to −0.71; P < 0.00001), as did fasting blood glucose (FBG) (MD = −0.56, 95% CI -0.88 to −0.25; P = 0.0005), 2 h postprandial blood glucose (2hPG) (MD = −0.91, 95% CI -1.62 to −0.20; P = 0.01), and fasting insulin (FINS) (MD = −3.23, 95% CI -4.14 to −2; P < 0.00001). Meanwhile, the insulin sensitivity index (ISI) (MD = 0.36, 95% CI 0.18 to 0.53; P < 0.0001) increased, and fewer adverse events occurred. Conclusion: Acupuncture may improve homa-IR, ISI, FBG, 2hPG and FINS with fewer adverse events than other treatments, making it a viable treatment for IR. © 2019 Elsevier Ltd