Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

Sam, Susan; Ehrmann, David A.

doi:10.1007/s00125-017-4306-3

Cited by 68 publications

(55 citation statements)

References 58 publications

(90 reference statements)

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“…Thus, it has become one of the most commonly used medications for type 2 diabetes worldwide, with more than 48 million prescriptions filled in the US in 2010. As described elsewhere in this issue of Diabetologia , metformin is also used for diabetes prevention [12] and the treatment of polycystic ovary syndrome [13], and there is hope that its use will expand to other indications, such as cancer treatment and/or prevention [14]. …”

Section: The Problemmentioning

confidence: 99%

The pharmacogenetics of metformin

Florez

2017

Diabetologia

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Despite its widespread use as the first-line agent for the treatment of type 2 diabetes, it has become clear that metformin does not work optimally for everyone. Elucidating who are the likely metformin responders and non-responders is hampered by our limited knowledge of its precise molecular mechanism of action. One approach to achieve the related goals of stratifying patients into response subgroups and identifying the molecular targets of metformin involves the deployment of agnostic genome-wide approaches in cohorts of appropriate size to attain sufficient statistical power. While candidate gene studies have shed some light on the role of genetic variation in influencing metformin response, genome-wide association studies are beginning to provide additional insight that is unconstrained by prior knowledge. To fully realise their potential, much larger samples need to be assembled via international collaboration, preferably involving the academic community, government and the pharmaceutical industry.

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Section: The Problemmentioning

confidence: 99%

The pharmacogenetics of metformin

Florez

2017

Diabetologia

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“…Hormonal contraceptives alone or combined with anti‐androgens have been the cornerstone for managing menstrual disturbances and clinical or biochemical hyperandrogenaemia; however, some hormonal contraceptives may unfavourably affect the lipid profile in PCOS and increase the risk of thrombosis and cardiovascular events in the general population . Glucose lowering agents including metformin and thiazolidinedione have been shown to be effective in managing the metabolic abnormalities (ie, insulin resistance, hyperinsulinaemia, and diabetes mellitus) and chronic anovulation; however, their use has been inconsistently associated with improvements in weight loss and body composition, menstrual irregularity or clinical symptoms of excess androgens …”

Section: Introductionmentioning

confidence: 99%

“…6 Glucose lowering agents including metformin and thiazolidinedione have been shown to be effective in managing the metabolic abnormalities (ie, insulin resistance, hyperinsulinaemia, and diabetes mellitus) and chronic anovulation; however, their use has been inconsistently associated with improvements in weight loss and body composition, menstrual irregularity or clinical symptoms of excess androgens. 7,8 Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is a new treatment option for adults with type 2 diabetes 9 ; however, its effects in PCOS have not been previously explored. Its principal action involves inhibition of glucose reabsorption by the kidney, and therefore, glucose excretion via urine.…”

Section: Introductionmentioning

confidence: 99%

Effects of empagliflozin on metabolic parameters in polycystic ovary syndrome: A randomized controlled study

Javed

Papageorgiou

Deshmukh

et al. 2019

Clinical Endocrinology

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Summary Background Empagliflozin is a sodium‐glucose‐cotransporter‐2 inhibitor that improves cardiovascular risk and promotes weight loss in patients with type‐2 diabetes. Polycystic ovary syndrome (PCOS) is associated with obesity and increased cardiovascular risk; therefore, empagliflozin may be of benefit for these women. The aim of this study was to compare the effects of empagliflozin vs metformin on anthropometric and body composition, hormonal and metabolic parameters in women with PCOS. Materials and methods A randomized open‐label study was conducted in women with PCOS who were randomized to either empagliflozin 25 mg (n = 19) or metformin 1500 mg (n = 20) daily for 12 weeks. The main outcomes assessed were changes in anthropometric and body composition, hormonal and metabolic parameters. Results Univariate analysis showed significant differences in weight (empagliflozin: −1.4 ± 3.2% vs metformin: 1.2 ± 2.3%; P = 0.006), body mass index (empagliflozin: −1.4 ± 3.2% vs metformin: 1.1 ± 2.2%; P = 0.006), waist circumference (empagliflozin: −1.6 ± 2.8% vs metformin: 0.2 ± 2.1%; P = 0.029) and hip circumference (empagliflozin: −2.0 ± 3.0% vs metformin: 1.1 ± 1.9%; P = 0.001), basal metabolic rate (empagliflozin: −1.8 ± 2.9% vs metformin: 0.1 ± 1.9%, P = 0.024) and fat mass (empagliflozin: −0.7 ± 4.9% vs metformin, 3.2 ± 5.0%; P = 0.023) between the empagliflozin and the metformin groups. These differences were confirmed in linear regression analysis after adjustment for relevant covariates. There were no significant changes in hormonal or metabolic parameters between both groups. Conclusion There was a significant improvement in anthropometric parameters and body composition, in overweight and obese women with PCOS after 12 weeks of treatment with empagliflozin compared to metformin, although no changes were seen in hormonal or metabolic parameters.

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“…In their review, Sam and Ehrmann [27] discuss the use of metformin for PCOS. In addition to its reproductive manifestations, PCOS also has metabolic consequences, including insulin resistance, impaired glucose tolerance and type 2 diabetes.…”

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confidence: 99%