Impact of pharmacological interventions on insulin resistance in women with polycystic ovary syndrome: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Objective Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterized by insulin resistance and is a major risk factor for type 2 diabetes mellitus (T2DM). The objective was to review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS. Design We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta‐ana. Reviwers extracted data and assessed the risk of bias using the Cochrane risk of bias tool. Results In 58 randomized controlled trials there were significant reductions in the fasting blood glucose (FBG) with metformin versus placebo (standardized mean difference [SMD]: −0.23; 95% confidence interval [CI]: −0.40, −0.06; I² = 0%, low‐grade evidence), and acarbose versus metformin (mean difference [MD]: −10.50 mg/dl; 95% CI: −15.76, −5.24; I² = 0%, low‐grade evidence). Significant reductions in fasting insulin (FI) with pioglitazone versus placebo (SMD: −0.55; 95% CI: −1.03, −0.07; I² = 37%; p = .02, very‐low‐grade evidence). A significant reduction in homoeostatic model assessment of insulin resistance (HOMA‐IR) was seen with exenatide versus metformin (MD: −0.34; 95% CI: −0.65, −0.03; I² = 0%, low‐grade evidence). No effect on homoeostatic model assessment of beta cells (HOMA‐B) was observed. Conclusions Pharmacological interventions, including metformin, acarbose, pioglitazone and exenatide have significant effects on FBG, FI, HOMA‐IR but not on HOMA‐B.

Effect of Hypoglycemic Drugs on Kisspeptin Expression in the Hypothalamic Arcuate Nucleus of PCOS Rats

“…Pioglitazone relieves insulin resistance by activating PPAR-γ to affect gene transcription related to glucose and lipid metabolism. 5 , 6 In addition, the Chinese guidelines for the diagnosis and treatment of PCOS in 2018 proposed that acarbose, as an alpha glycosidase inhibitor, not only reduces and slows the intestinal absorption of glucose but also increases insulin sensitivity, rectifies lipid metabolic disorders, and advances gastrointestinal function. Previous studies have also shown that acarbose adjusts the menstrual cycle of obese PCOS patients and that it can be used for the treatment of metabolic disorders in PCOS patients.…”

GLP-1 receptor agonists, polycystic ovary syndrome and reproductive dysfunction: Current research and future horizons

“…66 Most of their important effects were also illustrated in several recent meta-analyses; monotherapy with GLP-1R agonists or their combination with MET were superior to MET monotherapy in terms of reduction of waist circumference, body weight and BMI. [67][68][69][70][71][72][73] In order to enhance the cardiometabolic and hormonal defects associated with this syndrome, the potential combination of GLP-1R agonists/sodium-glucose co-transporter 2 (SGLT2) inhibitors is also being studied. 57,74 Decreased free T levels and FAI have been shown both after LIRA and EXE administration.…”

Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

“…A preplanned protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42016050444) by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions [18]. Furthermore, our review is described based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [19].…”