Abstract
Context: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterised by insulin resistance and is a major cause for type 2 diabetes mellitus (T2DM). Objective: To review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS. Data sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. Study selection: The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Data extraction: Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool. Data synthesis: 58 RCTs there were significant reductions in the fasting blood glucose (FBG) with metformin vs placebo (mean difference (MD): -0.16 mg/dL; 95% CI: -0.28, -0.04, I² = 0%, low grade evidence), and acarbose vs metformin (MD: -10.50 mg/dL; 95% CI: -15.76, -5.24, I² = 0%, low grade evidence). Significant reductions in fasting insulin (FI) in metformin vs placebo (MD: -2.20 pmol/L; 95% CI: -3.62, -0.77, I²= 0%, moderate grade evidence) and with pioglitazone vs placebo (MD: -11.47 pmol/L; 95% CI: -20.20, -2.74, I²= 35%, p = 0.01, very low-grade evidence). A significant reduction in HOMA-IR was seen with exenatide vs metformin(MD: -0.34; 95% CI: -0.65, -0.03, I²= 0%, low grade evidence). No effect on HOMA-B was observed. Conclusion: pharmacological interventions including metformin, acarbose, pioglitazone, and exenatide appeared to have significant effects on FBG, FI, HOMA-IR but not on HOMA-B.
Context: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterised by insulin resistance and is a major cause for type 2 diabetes mellitus (T2DM). Objective: To review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS. Data sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. Study selection: The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Data extraction: Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool. Data synthesis: 58 RCTs there were significant reductions in the fasting blood glucose (FBG) with metformin vs placebo (mean difference (MD): -0.16 mg/dL; 95% CI: -0.28, -0.04, I² = 0%, low grade evidence), and acarbose vs metformin (MD: -10.50 mg/dL; 95% CI: -15.76, -5.24, I² = 0%, low grade evidence). Significant reductions in fasting insulin (FI) in metformin vs placebo (MD: -2.20 pmol/L; 95% CI: -3.62, -0.77, I²= 0%, moderate grade evidence) and with pioglitazone vs placebo (MD: -11.47 pmol/L; 95% CI: -20.20, -2.74, I²= 35%, p = 0.01, very low-grade evidence). A significant reduction in HOMA-IR was seen with exenatide vs metformin(MD: -0.34; 95% CI: -0.65, -0.03, I²= 0%, low grade evidence). No effect on HOMA-B was observed. Conclusion: pharmacological interventions including metformin, acarbose, pioglitazone, and exenatide appeared to have significant effects on FBG, FI, HOMA-IR but not on HOMA-B.