TY - JOUR
T1 - Impact of pharmacological interventions on insulin resistance in women with polycystic ovary syndrome
T2 - A systematic review and meta-analysis of randomized controlled trials
AU - Abdalla, Mohammed A.
AU - Shah, Najeeb
AU - Deshmukh, Harshal
AU - Sahebkar, Amirhossein
AU - Östlundh, Linda
AU - Al-Rifai, Rami H.
AU - Atkin, Stephen L.
AU - Sathyapalan, Thozhukat
N1 - Funding Information:
The authors thank Dr. Gamila Hassan at the National Medical Library (UAEU) for her support with locating and uploading full-text papers to Covidence for screening. This systematic review was completed as part of a self-funded PhD project for Mohammed Altigani Abdalla, and no external fund was received.
Publisher Copyright:
© 2021 John Wiley & Sons Ltd.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - FBG
KW - FI
KW - HOMA-B
KW - HOMA-IR
KW - PCOS
KW - pharmacological therapy
KW - polycystic ovary syndrome
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U2 - 10.1111/cen.14623
DO - 10.1111/cen.14623
M3 - Review article
C2 - 34713480
AN - SCOPUS:85118207242
SN - 0300-0664
VL - 96
SP - 371
EP - 394
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 3
ER -