Clinical, endocrine, and metabolic effects of acarbose, a α-glucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome

Tuğrul, Semih; Kutlu, Tayfun; Pekin, Oya; Baglam, Elif; Kıyak, Hüseyin; Oral, Onur

doi:10.1016/j.fertnstert.2007.07.1326

Cited by 22 publications

(11 citation statements)

References 18 publications

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“…To date few studies addressed the effects of acarbose on women with PCOS [32–36]. In only two studies acarbose reduced insulin level and/or parameters of insulin resistance [32,35] while in other studies no improvement was noted [33,36]. A beneficial effect of acarbose on lipid profile was also reported by some [34,35] but not all investigators [36].…”

Section: Acarbosementioning

confidence: 99%

“…In only two studies acarbose reduced insulin level and/or parameters of insulin resistance [32,35] while in other studies no improvement was noted [33,36]. A beneficial effect of acarbose on lipid profile was also reported by some [34,35] but not all investigators [36]. One placebo-controlled trial indicated that acarbose reduced blood pressure and improved endothelial function [34].…”

Section: Acarbosementioning

confidence: 99%

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Medical management of metabolic dysfunction in PCOS

Dulęba

2012

Steroids

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Polycystic ovary syndrome (PCOS) is associated with metabolic derangements including insulin resistance, dyslipidemia, systemic inflammation and endothelial dysfunction. There is a growing need to develop pharmacologic interventions to improve metabolic function in women with PCOS. Medications that have been tested in patients with PCOS include metformin, thiazolidinediones, acarbose, naltrexone, orlistat, vitamin D and statins. Metformin decreases hepatic gluconeogenesis and free fatty acid oxidation while increasing peripheral glucose uptake. Early studies in PCOS suggested that metformin indirectly reduces insulin level, dyslipidemia and systemic inflammation; however, recent placebo-controlled trials failed to demonstrate significant metabolic benefit. Thiazolidinediones act primarily by increasing peripheral glucose uptake. Most studies in PCOS have demonstrated that thiazolidinediones reduce insulin resistance; however, effects on dyslipidemia were disappointing. Use of thiazolidinediones is associated with weight gain and major complications. Acarbose reduces digestion of polysaccharides. Studies in PCOS yielded inconsistent effects of acarbose on insulin sensitivity and no significant improvement of dyslipidemia. Naltrexone reduces appetite and modulates insulin release; its use in PCOS may reduce hyperinsulinemia. Orlistat decreases absorption of dietary fats; studies in PCOS suggest beneficial effects on insulin sensitivity. Vitamin D may improve insulin sensitivity but mixed results on lipid profile in PCOS have been reported. Statins are competitive inhibitors of the key enzyme regulating the mevalonate pathway; their effects are related to reduced cholesterol production as well as anti-inflammatory and anti-oxidant properties. In women with PCOS, statins reduce hyperandrogenism, improve lipid profile and reduce systemic inflammation while the effects on insulin sensitivity are variable. Use of statins is contraindicated in pregnancy.

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Section: Acarbosementioning

confidence: 99%

Section: Acarbosementioning

confidence: 99%

Medical management of metabolic dysfunction in PCOS

Dulęba

2012

Steroids

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“…[72][73][74][75] The potential role of acarbose in PCOS has been studied, but its effects on insulin sensitivity parameters, body mass, and vascular function were inconsistent and there was no significant improvement of PCOS-related dyslipidemia. 74,75 Adverse effects, predominantly gastrointestinal, are common, and potentially fatal hepatotoxicity has been reported.…”

Section: Acarbosementioning

confidence: 99%

Advances in Treatment Options for Polycystic Ovary Syndrome

Lathief¹,

Pal²

2012

US Endocrinology

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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy seen in women of reproductive age. Clinical concerns relating to PCOS range from ovulatory infertility and menstrual disorders to risk of diabetes and cardiovascular disease. Hormonal contraceptives have been the mainstay of the management of common PCOS symptoms, such as menstrual irregularity and clinical stigmata of androgen excess (i.e., hirsutism and acne). An appreciation of the relevance of metabolic pathways in the pathophysiology of PCOS is relatively recent, and has translated into an expansion of the therapeutic strategies available for the management of PCOS.Insulin sensitizers were one of the first metabolic modulators to be incorporated in the clinical management paradigm, albeit with mixed results. Recognizing that insulin resistance is central to the pathophysiology of PCOS, newer agents-e.g., thiazolidinedionesfollowed, with almost comparable efficacy to metformin. Statins and most recently incretins constitute novel therapies with distinct metabolic targets that seem to hold promise in the management of PCOS. In tandem with the expansion in pharmaceuticals, a host of complementary and alternative medical therapies have generated interest for purported promise in the management of PCOS, including vitamin D, acarbose, and myo-inositol. The therapeutic options for managing PCOS-related infertility have also expanded. Clomiphene citrate (CC) has long been the first-line strategy for ovulation induction in the setting of anovulatory infertility; however, aromatase inhibitors are fast gaining acceptance as an ovulation induction strategy, with results comparable or even better than those seen with CC. An increasing level of therapeutic sophistication is reflected in ovarian stimulation protocols judiciously using gonadotropins, gonadotropin-releasing hormone antagonists, the procedure of ovarian drilling, and assisted reproductive technologies with in vitro oocyte maturation. KeywordsPolycystic ovary syndrome, androgen, oral contraceptive, antiandrogen, spironolactone, finasteride, flutamide, eflornithine, insulin, metformin, thiazolidinediones, incretins, statins, acarbose, myo-inositol In this article, the authors have attempted to provide an overview of the treatment options that offer therapeutic benefit in PCOS. Treatment Options for Targeting Common Symptoms Combined Oral ContraceptivesHaving long been used as the first-line treatment in PCOS management, combined oral contraceptives (COCs) offer not just menstrual regulation and endometrial protection, but also a benefit against cutaneous stigmata of hyperandrogenism in women with PCOS. 5-7Mechanisms whereby COCs mediate improvements in PCOS-related symptoms include:• a suppression of pituitary luteinizing hormone (LH), thereby reducing the stimulant effect of LH on androgen production by the ovarian theca cells;• an increase in hepatic sex hormone binding globulin (SHBG) directly resulting from the estrogen component in the COC; the net effect is a

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“…In a one year, double-blind, randomized, placebo-controlled study in type 2 diabetes subjects, the individuals receiving acarbose lost 0.5 kg while the placebo group gained 0.3 kg 141. Administration of acarbose (150 mg/day) to women with polycystic ovary syndrome significantly reduced body weight and BMI 142–144…”

Section: Drugs That Interfere With Carbohydrate Absorptionmentioning

confidence: 99%

The role of lipid and carbohydrate digestive enzyme inhibitors in the management of obesity: a review of current and emerging therapeutic agents

Tucci

Boyland²,

Halford³

2010

DMSOTT

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Obesity is a global epidemic associated with significant morbidity and mortality in adults and ill health in children. A proven successful approach in weight management has been the disruption of nutrient digestion, with orlistat having been used to treat obesity for the last 10 years. Although orlistat-induced weight loss remains modest, it produces meaningful reductions in risk factors for obesity-related conditions such as diabetes and cardiovascular disease. Moreover, this lipase inhibitor is free of the serious side effects that have dogged appetite-suppressing drugs. This success had driven investigation into new generation nutraceuticals, supplements and pharmaceutical agents that inhibit the breakdown of complex carbohydrates and fats within the gut. This review focuses on agents purported to inhibit intestinal enzymes responsible for macronutrient digestion. Except for some synthetic products, the majority of agents reviewed are either botanical extracts or bacterial products. Currently, carbohydrate digestion inhibitors are under development to improve glycemic control and these may also induce some weight loss. However, colonic fermentation induced side effects, such as excess gas production, remain an issue for these compounds. The α-glucosidase inhibitor acarbose, and the α-amylase inhibitor phaseolamine, have been used in humans with some promising results relating to weight loss. Nonetheless, few of these agents have made it into clinical studies and without any clinical proof of concept or proven efficacy it is unlikely any will enter the market soon.

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Clinical, endocrine, and metabolic effects of acarbose, a α-glucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome

Cited by 22 publications

References 18 publications

Medical management of metabolic dysfunction in PCOS

Medical management of metabolic dysfunction in PCOS

Advances in Treatment Options for Polycystic Ovary Syndrome

The role of lipid and carbohydrate digestive enzyme inhibitors in the management of obesity: a review of current and emerging therapeutic agents

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