Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with the polycystic ovary syndrome

Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate whether pioglitazone decreases insulin resistance (IR) and hyperandrogenism to the same extent as metformin in obese women with PCOS who have not received any previous treatment. Fifty-two women with PCOS were randomly allocated to receive either pioglitazone (30 mg/d, n = 25) or metformin (850 mg three times daily, n = 27) and were assessed before and after 6 months. Body weight, body mass index, and waist to hip ratio increased significantly (P ≤ 0.05) after pioglitazone treatment but not after metformin treatment. Fasting serum insulin concentration (P < 0.001 for both drugs) and the area under the insulin curve during a 2-h oral glucose tolerance test decreased after pioglitazone (P < 0.002) or metformin (P < 0.05) treatment. IR (homeostasis model of assessment-IR index) decreased and insulin sensitivity (elevation of the quantitative insulin sensitivity check index and the fasting glucose to insulin ratio) increased (P ≤ 0.008) after treatment with either drug. Hirsutism (P < 0.05) and serum concentrations of free testosterone (P < 0.02) and androstenedione (P < 0.01) declined to a similar extent after treatment with the drugs. Treatment with pioglitazone or metformin was associated with the occurrence of pregnancy (n = 5 and n = 3, respectively). These results suggest that pioglitazone is as effective as metformin in improving insulin sensitivity and hyperandrogenism, despite an increase in body weight, body mass index, and the waist to hip ratio associated with pioglitazone.

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Failure of Mathematical Indices to Accurately Assess Insulin Resistance in Lean, Overweight, or Obese Women with Polycystic Ovary Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2003-031205 ◽

2004 ◽

Vol 89 (3) ◽

pp. 1273-1276 ◽

Cited By ~ 99

Author(s):

Evanthia Diamanti-Kandarakis ◽

Chryssa Kouli ◽

Krystallenia Alexandraki ◽

Giovanna Spina

Keyword(s):

Insulin Resistance ◽

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Statistical Difference ◽

Polycystic Ovary ◽

Total Testosterone ◽

Obese Women ◽

Ovary Syndrome ◽

Overweight Women ◽

Euglycemic Clamp

Abstract Insulin resistance is a common metabolic feature of polycystic ovary syndrome (PCOS). In this study, we examined the validity of the mathematical indices [the quantitative insulin sensitivity check index (QUICKI) and the homeostasis model of assessment (HOMA)] that calculate insulin sensitivity and their correlation to glucose utilization with the insulin infusion rate in 40 mU/m2·min by the euglycemic clamp (M) in women with PCOS. We studied 59 women with PCOS (20 lean, 16 overweight, and 23 obese subjects). Euglycemic clamp testing was performed, and QUICKI, HOMA, total testosterone, fasting insulin, fasting glucose, and glucose-to-insulin ratio were estimated. No difference was found in testosterone and glucose levels among the three groups. Lean or overweight women compared with obese women differed in insulin levels, glucose-to-insulin ratio, QUICKI, and HOMA (P < 0.01). No statistical difference was found between lean and overweight women in the above parameters. M differed when lean women were compared with overweight (P < 0.002) or obese women (P < 0.0001); however, no statistical difference was observed between overweight and obese women. No significant correlation was found between M and QUICKI or HOMA. We conclude that mathematical indices should be applied with caution in different insulin-resistant populations and should not be considered a priori equivalent to the euglycemic clamp technique.

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Plasma omentin-1 levels are reduced in non-obese women with normal glucose tolerance and polycystic ovary syndrome

Acta Endocrinologica ◽

10.1530/eje-11-0375 ◽

2011 ◽

Vol 165 (5) ◽

pp. 789-796 ◽

Cited By ~ 31

Author(s):

Ji-Hun Choi ◽

Eun-Jung Rhee ◽

Kye-Hyun Kim ◽

Hee-Yeon Woo ◽

Won-Young Lee ◽

...

Keyword(s):

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Glucose Tolerance ◽

Polycystic Ovary ◽

Normal Glucose Tolerance ◽

Obese Women ◽

Ovary Syndrome ◽

C Peptide ◽

Normal Glucose ◽

Androgen Levels

ObjectiveOmentin-1 is a novel adipokine that increases insulin sensitivity and is expressed in visceral adipose tissue. The aim of this study was to determine the metabolic parameters that influence plasma omentin-1 levels in women with polycystic ovary syndrome (PCOS).Design and methodsA cross-sectional study was performed in 87 women with PCOS and 53 body mass index (BMI)-matched healthy controls including 39 non-obese, normal-weight (NW) PCOS women with normal glucose tolerance (NGT) and 44 BMI- and homeostasis model assessment (HOMA)-matched controls. Indices of insulin sensitivity, metabolic variables, circulating androgen levels, serum adiponectin, and omentin-1 levels were measured. A 75 g oral glucose tolerance test was performed in all participants.ResultsPlasma omentin-1 levels were significantly lower in women with PCOS compared with those in BMI-matched controls (P<0.001). A significantly lower level of plasma omentin-1 was observed in non-obese women with PCOS and NGT compared with that in BMI- and HOMA-matched controls (P<0.001). Omentin-1 level was negatively correlated with BMI, indices of insulin sensitivity, and circulating androgens and was associated with greater 2 h postprandial glucose, C-peptide, and insulin levels compared with fasting values. Within the NW and NGT groups, omentin-1 levels remained negatively correlated with BMI, 2 h postprandial C-peptide, and circulating androgens and demonstrated a negative linear trend according to quartile of free testosterone (P=0.028).ConclusionsPlasma levels of omentin-1 were reduced in non-obese women with PCOS and NGT. Postprandial hyperinsulinemia and hyperglycemia contributed more to lower omentin-1 levels than did fasting values in the setting of PCOS. Increased androgen levels contributed to decreased omentin-1 levels in women with PCOS.

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EFFECTS OF METFORMIN ON THE BLOOD LIPID PROFILE AND INSULIN SENSITIVITY IN OBESE WOMEN WITH POLYCYSTIC OVARY SYNDROME

Heart ◽

10.1136/heartjnl-2012-302920h.2 ◽

2012 ◽

Vol 98 (Suppl 2) ◽

pp. E155.3-E156

Author(s):

Erhong Zhang ◽

Ping Wang ◽

Xiaoyan Li ◽

Weijie Xing ◽

Xin Tao ◽

...

Keyword(s):

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Lipid Profile ◽

Polycystic Ovary ◽

Blood Lipid ◽

Obese Women ◽

Ovary Syndrome ◽

Blood Lipid Profile

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Insulin sensitivity does not differentiate by hirsutism in non-obese women with polycystic ovary syndrome

Endocrine Journal ◽

10.1507/endocrj.k07-069 ◽

2008 ◽

Vol 55 (3) ◽

pp. 465-468 ◽

Cited By ~ 3

Author(s):

Emine COSAR ◽

Gulengul KOKEN ◽

Figen Kir SAHIN ◽

Dagistan Tolga ARIOZ ◽

Mehmet YILMAZER

Keyword(s):

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Obese Women ◽

Ovary Syndrome

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No changes of peripheral insulin resistance in polycystic ovary syndrome after long-term reduction of endogenous androgens with leuprolide

Acta Endocrinologica ◽

10.1530/eje.0.1330718 ◽

1995 ◽

Vol 133 (6) ◽

pp. 718-722 ◽

Cited By ~ 7

Author(s):

Antonino Lasco ◽

Domenico Cucinotta ◽

Alfonso Gigante ◽

Giulia Denuzzo ◽

Marilena Pedulla ◽

...

Keyword(s):

Insulin Resistance ◽

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Obese Women ◽

Ovary Syndrome ◽

Control Subjects ◽

Peripheral Insulin Resistance ◽

Androgen Levels

Lasco A, Cucinotta D, Gigante A, Denuzzo G, Pedulla M, Trifiletti A, Frisina N. No changes of peripheral insulin resistance in polycystic ovary syndrome after long-term reduction of endogenous androgens with leuprolide. Eur J Endocrinol 1995;133:718–22. ISSN 0804–4643 The aim of this study was to investigate the relationship between plasma insulin levels, peripheral insulin sensitivity and androgen secretion in ten patients with polycystic ovary syndrome and in six obese women as compared with six normal-weight control subjects. During a euglycemic–hyperinsulinemic clamp no significant change of testosterone, androstenedione or dehydroepiandrosterone sulfate plasma levels was observed in the two groups of patients or in the control subjects; insulin sensitivity was clearly reduced and was similar in polycystic ovary patients and in obese women, in spite of the different plasma androgen levels. A long-term (5 months) androgen suppression with the gonadotropin-releasing hormone agonist leuprolide was not able to improve significantly the insulin sensitivity. These results demonstrate that the short-term hyperinsulinemia achieved with the clamp technique does not affect androgen secretion and that insulin resistance, measured with the same technique, is not influenced by long-term suppression of plasma androgen levels in polycystic ovary syndrome. A Lasco, Via Faustina e Tertullo 19, 98100 Messina, Italy

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