Premium
Effect of metformin, orlistat and pioglitazone treatment on mean insulin resistance and its biological variability in polycystic ovary syndrome
Author(s) -
Cho L. W.,
Kilpatrick E. S.,
Keevil B. G.,
Coady A. M.,
Atkin S. L.
Publication year - 2009
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2008.03309.x
Subject(s) - orlistat , metformin , medicine , polycystic ovary , pioglitazone , endocrinology , insulin resistance , insulin , weight loss , type 2 diabetes , diabetes mellitus , obesity
Summary Context Mean insulin resistance (IR) is greater and it is also more variable in overweight women with polycystic ovarian syndrome (PCOS) compared to weight matched controls. Whilst treatment will reduce the mean IR, it is not known if the IR variability is also reduced. Objective To compare the change in IR and its variability before and after treatment with insulin sensitization through metformin and pioglitazone, compared to that induced by weight loss with orlistat. Design Randomized, open labelled parallel study. Setting Endocrinology outpatient clinic at a referral centre. Patients Thirty obese PCOS patients [BMI 36·0 ± 1·2 kg/m 2 (mean ± SEM)] participated in the study. Intervention The change in biological variability (BV) was assessed by measuring IR (homeostasis model assessment method) at 4‐day intervals on 10 consecutive occasions before and 12 weeks after randomization to metformin, pioglitazone or orlistat. Outcome measured The primary end point of the study was a change in BV of IR. Results Treatment with pioglitazone, orlistat and metformin reduced the overall IR by 41·0 ± 4·1%, 19·7 ± 6·4% and 16·1 ± 6·8% ( P = 0·005, P = 0·013, P = 0·17, respectively) and IR variability by 28·5 ± 18·0%, 41·8 ± 11·6% and 23·7 ± 17·0 ( P = 0·20, P = 0·015 and P = 0·28, respectively). Free androgen index reduced significantly with all treatments. Conclusion Only orlistat reduced both IR and its variability significantly, though all three drugs were effective in reducing hyperandrogenism within the 12‐week period of the study.