Comparison of metformin and thiazolidinediones in the management of polycystic ovary syndrome

Baillargeon, Jean-Patrice; Iuorno, Maria J.; Nestler, John E.

doi:10.1097/00060793-200208000-00003

Cited by 12 publications

(6 citation statements)

References 93 publications

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Section: Diabetes Care 29:300 -305 2006mentioning

confidence: 99%

“…It is defined by hyperandrogenism, chronic anovulation, and/or polycystic ovaries (1,2) and affects 6 -10% of women of childbearing age (3-5). PCOS is the most common cause of anovulatory infertility in the U.S. and is associated with an increased risk of developing cancer, hypertension, dyslipidemia, impaired glucose tolerance or type 2 diabetes, and cardiovascular disease (3,4,6).During the past decade, increasing evidence supports the central role of insulin resistance and/or compensatory hyperinsulinemia in the syndrome's pathogenesis (3,7,8). Obese and lean women with PCOS manifest insulin resistance independent of fat mass (3,9), and administration of insulin-sensitizing drugs, such as metformin (3), troglitazone (3), and D-chiro-inositol (DCI) (10 -12), to both obese and lean women with the syndrome increases the frequency of ovulation and decreases circulating androgens.…”

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confidence: 99%

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Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome

et al. 2006

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OBJECTIVE -Evidence suggests that some actions of insulin are effected by inositolphosphoglycan (IPG) mediators. We hypothesize that a deficiency in D-chiro-inositol (DCI) and/or a DCI-containing IPG (DCI-IPG) may contribute to insulin resistance in humans.RESEARCH DESIGN AND METHODS -To assess this possibility in polycystic ovary syndrome (PCOS), we determined insulin sensitivity (S i by frequently sampled intravenous glucose tolerance test), plasma and urinary DCI and myo-inositol (MYO) levels (by gas chromatography/mass spectrometry), and the release of insulin and DCI-IPG during the oral glucose tolerance test (area under the curve [AUC]) in 23 women with PCOS and 26 normal women.RESULTS -Women with PCOS were heavier than control subjects (P ϭ 0.002 for BMI), but also had decreased S i (P Ͻ 0.001) and increased AUC insulin (P Ͻ 0.001) compared with normal women, even when corrected for BMI. The urinary clearance of DCI (uCl DCI ) was increased almost sixfold in PCOS compared with normal women (P ϭ 0.001), but not MYO clearance (P ϭ 0.10). uCl DCI correlated inversely with S i when all women were analyzed together (n ϭ 49, r ϭ Ϫ0.50, P Ͻ 0.001) and was one of the three best independent parameters predicting S i . Finally, the ratio of AUC DCI-IPG to AUC insulin was decreased threefold in women with PCOS (P Ͻ 0.001).CONCLUSIONS -uCl DCI is inversely correlated with insulin sensitivity in women and is a strong independent predictor of insulin resistance in multivariate models. PCOS, which is characterized by insulin resistance, is associated with a selective increase in uCl DCI and impaired DCI-IPG release in response to insulin. These findings are consistent with a defect in tissue availability or utilization of DCI in PCOS that may contribute to the insulin resistance of the syndrome. Diabetes Care 29:300 -305, 2006P olycystic ovary syndrome (PCOS) is a prevalent but poorly understood disorder associated with significant adverse short-and long-term health consequences. It is defined by hyperandrogenism, chronic anovulation, and/or polycystic ovaries (1,2) and affects 6 -10% of women of childbearing age (3-5). PCOS is the most common cause of anovulatory infertility in the U.S. and is associated with an increased risk of developing cancer, hypertension, dyslipidemia, impaired glucose tolerance or type 2 diabetes, and cardiovascular disease (3,4,6).During the past decade, increasing evidence supports the central role of insulin resistance and/or compensatory hyperinsulinemia in the syndrome's pathogenesis (3,7,8). Obese and lean women with PCOS manifest insulin resistance independent of fat mass (3,9), and administration of insulin-sensitizing drugs, such as metformin (3), troglitazone (3), and D-chiro-inositol (DCI) (10 -12), to both obese and lean women with the syndrome increases the frequency of ovulation and decreases circulating androgens.Some actions of insulin may be affected by putative inositolphosphoglycan (IPG) mediators of insulin action (13,14), and evidence suggests that a deficiency in a specifi...

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Section: Diabetes Care 29:300 -305 2006mentioning

confidence: 99%

mentioning

confidence: 99%

Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome

et al. 2006

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“…The presence of insulin resistance (IR) and secondary hyperinsulinemia, mainly in obese women with PCOS (Burghen et al 1980), is considered the key factor responsible for their hyperandrogenism (Dunaif 1997, Baillargeon et al 2002. Previous studies have proposed that women with PCOS also have a disruption of the neuroendocrine mechanisms (mainly a deficiency of hypothalamic dopamine) regulating both gonadotropinreleasing hormone and prolactin (PRL) release (Quigley et al 1981, Rosenfield, 1997, Taylor et al 1997.…”

Section: Introductionmentioning

confidence: 99%

Insulin sensitizing drugs increase the endogenous dopaminergic tone in obese insulin-resistant women with polycystic ovary syndrome

Ortega-González¹,

Cardoza²,

Coutiño³

et al. 2005

Journal of Endocrinology

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To investigate whether the long-term administration of metformin or pioglitazone to women with polycystic ovary syndrome (PCOS) could induce changes in their hypothalamic dopaminergic (DA) tone and to analyze whether these changes correlated with modifications in insulin resistance, we originally studied 57 obese hyperinsulinemic, non-diabetic, insulin resistant women with PCOS, but only 34 completed the study. They were randomly divided into two groups: group one (n=17) received pioglitazone (30 mg/day) and group 2 (n=17) received metformin (850 mg, three times a day) over 24 weeks. All women were identically studied before (basal) and 6 months after (T6) drug administration, including clinical evaluations, a 2 h oral glucose tolerance test (75 g) (OGTT) for glucose and insulin measurements, followed a week later by a 2 h intravenous metoclopramide test (10 mg bolus) for prolactin (PRL) determinations. The areas under the insulin (AUC-insulin) and PRL (AUC-PRL) curves were calculated, along with the index of insulin resistance (HOMA-IR) and the indexes of insulin sensitivity (QUICKI and fasting glucose-insulin ratio). At baseline, women in both groups were of similar age, body weight, body mass index (BMI) and FerrimanGallwey hirsutism score (F-G score). At completion of the study, body weight and BMI remained unchanged but the F-G score significantly decreased. Fasting serum insulin concentrations and the AUC-insulin significantly decreased by the end of the trial in a similar fashion in both groups, while the AUC-PRL significantly increased at the end of the trial in both groups. At no time were significant correlations between AUC -PRL and AUC-insulin or the indexes HOMA-IR, QUICKI or fasting glucose-insulin ratio observed. The present results suggests that either pioglitazone or metformin administration was associated with a clear improvement in the endogenous hypothalamic DA tone, simultaneously with an amelioration of the insulin resistance status in these obese women with PCOS.

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“…Although the basic pathogenesis of PCOS is uncertain, insulin resistance and resulting compensatory hyperinsulinemia have been demonstrated to play a key role in hyperandrogenism, follicular development, and anovulation (2)(3)(4), and several studies have suggested that reduction of insulin resistance improves ovulation and fertility (5)(6)(7). Consequently, insulin-sensitizing drugs such as biguanides (e.g., metformin) and thiazolidinediones (e.g., rosiglitazone, pioglitazone) have afforded new treatment options for PCOS (7)(8)(9)(10).…”

mentioning

confidence: 99%

Effects of pioglitazone on ovarian stromal blood flow, ovarian stimulation, and in vitro fertilization outcome in patients with polycystic ovary syndrome

Kim

Jeon

Kim

et al. 2010

Fertility and Sterility

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Comparison of metformin and thiazolidinediones in the management of polycystic ovary syndrome

Cited by 12 publications

References 93 publications

Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome

Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome

Insulin sensitizing drugs increase the endogenous dopaminergic tone in obese insulin-resistant women with polycystic ovary syndrome

Effects of pioglitazone on ovarian stromal blood flow, ovarian stimulation, and in vitro fertilization outcome in patients with polycystic ovary syndrome

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