Effects of Pioglitazone and Metformin on Insulin Resistance Reduction in Polycystic Ovary Syndrome: A Comparative Study

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Internal Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

2 Assistant Professor, Department of Internal Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

3 Internist, Avicenna Hospital, Qazvin, Iran

4 Lecturer, Department of Biostatistics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Background: Polycystic ovary syndrome (PCOS) is among the most common endocrine disorders in women of reproductive age and affects 7% of this population. PCOS is identified as a reproductive disorder characterized by an ovulation, hyperandrogenism and insulin resistance. PCOS increases the risk for type 2 diabetes mellitus and metabolic syndrome, a constellation of cardiovascular risk factors associated with insulin resistance. The aim of our study was to investigate and compare insulin resistance reduction and chemical changes during the application of insulin sensitizers from two different groups (metformin and pioglitazone).Methods: This randomized clinical trial lasted for 3 months and was conducted in Avicenna Hospital, Qazvin, Iran. Overall, 56 women with PCOS were randomly divided into two groups. Group 1 received 500 mg metformin three times daily and group 2 was treated with pioglitazone 30 mg per day. Serum levels of insulin, fasting blood sugar (FBS), and lipid metabolism parameters including triglyceride (TG), cholesterol (Chol), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were measured before the treatment and in the 3rd month. Homeostasis model assessment of insulin resistance (HOMA-IR) was used. Body mass index (BMI) was also calculated at baseline and at the end of therapy.Findings: Before the treatment, the two groups matched for age, weight, and BMI (P > 0.05). Before the treatment, there were no statistically significant differences in FBS, HDL, LDL, TG, Chol and serum levels of insulin between the two groups. Three months after treatment, mean serum levels of FBS, TG, Chol, LDL and insulin decreased significantly in both groups. Moreover, the treatment significantly increased HDL levels in both groups (P < 0.01). In metformin group, mean values of BMI before and after treatment were 26.1 and 25.5 (P < 0.05). The corresponding values in pioglitazone group were 25.9 and 25.2 (P > 0.05). Conclusion: Our findings showed that in women with PCOS, treatment with metformin and pioglitazone for 3 months resulted in similar beneficial effects on laboratory parameters of insulin sensitization. However, there is no evidence that pioglitazone improves BMI when compared to metformin. Further research is needed to investigate whether treatment with insulin sensitizers in women with PCOS can also reduce cardiovascular risk factors.

Keywords

References

  1. Fowler B. Disorders of homocysteine metabolism. J Inherit Metab Dis 1997; 20(2): 270-85.
  2. Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91(4): 1357-63.
  3. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352(12): 1223-36.
  4. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393-403.
  5. Mathur R, Stöppler MC. Insulin Resistance. [cited 2007 Aug 2]; Available from: URL: http://www.medicinenet.com/insulin_resistance/article.htm.
  6. Unluhizarci K, Karababa Y, Bayram F, Kelestimur F. The investigation of insulin resistance in patients with idiopathic hirsutism. J Clin Endocrinol Metab 2004; 89(6): 2741-4.
  7. Zheng Z, Li M, Lin Y, Ma Y. Effect of rosiglitazone on insulin resistance and hyperandrogenism in polycystic ovary syndrome. Zhonghua Fu Chan Ke Za Zhi 2002; 37(5): 271-3.
  8. Albareda M, Rodriguez-Espinosa J, Murugo M, de LA, Corcoy R. Assessment of insulin sensitivity and beta-cell function from measurements in the fasting state and during an oral glucose tolerance test. Diabetologia 2000; 43(12): 1507-11.
  9. Jayagopal V, Kilpatrick ES, Holding S, Jennings PE, Atkin SL. The biological variation of insulin resistance in polycystic ovarian syndrome. J Clin Endocrinol Metab 2002; 87(4): 1560-2.
  10. Ortega-Gonzalez C, Luna S, Hernandez L, Crespo G, Aguayo P, Arteaga-Troncoso G, et al. Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90(3): 1360-5.
  11. Checa MA, Requena A, Salvador C, Tur R, Callejo J, Espinos JJ, et al. Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome. Hum Reprod Update 2005; 11(4): 375-90.
  12. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf) 1999; 51(6): 779-86.
  13. Glueck CJ, Moreira A, Goldenberg N, Sieve L, Wang P. Pioglitazone and metformin in obese women with polycystic ovary syndrome not optimally responsive to metformin. Hum Reprod 2003; 18(8): 1618-25.
Journal of Isfahan Medical School
Volume 29, Issue 172 - Serial Number 172
November and December 2012
Pages 2842-2848

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History

  • Receive Date: 18 March 2012
  • Revise Date: 27 May 2024
  • Accept Date: 06 April 2022

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