Insulin resistance assessment in patients with polycystic ovary syndrome using different diagnostic criteria – Impact of metformin treatment
More details
Hide details
Department of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
Clinic of Neurology, Pomeranian Medical University, Szczecin, Poland
Sylwester Ciecwiez   

Department of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
Ann Agric Environ Med. 2013;20(3):528–532
Introduction and objective:
Polycystic ovary syndrome (PCOS) is one of the most frequent reasons for anovulation in infertile women. It can affect 5% – 10% of women of reproductive age. One of the important factors associated with the typical clinical signs and hormonal disorders could be insulin resistance and hyperinsulinaemia. The primary objective of this study was to assess the prevalence of insulin resistance in PCOS women. The secondary objective was to evaluate changes in body mass index (BMI), waist-to-hip ratio (WHR), and insulin sensitivity after 3 months of metformin therapy

Material and Methods:
68 patients were enrolled in the study. In all participants fasting and 2-h post-load glucose and insulin levels, WHR and BMI were evaluated before and after metformin (2 x 850 mg) therapy. Insulin resistance was assessed using G0/I0, G120/I120, and HOMA-IR indexes

Before the treatment, insulin resistance was observed in 26% patients according to HOMA-IR, and in 16% or 28% according to G0/I0 or G120/I120, respectively. Metformin therapy was associated with improvement in insulin sensitivity in HOMA-IR and G120/I120 defined insulin resistant patients.

The percentage of insulin resistant PCOS patients differed depending on the method applied. It is necessary to find a single most useful method to measure insulin resistance. Metformin treatment significantly improves insulin sensitivity in insulin resistant patients.

Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States; a prospective study. J Clin Endocrinol Metab. 1998; 83: 3078–3082.
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008; 23: 462–477.
Radomski D, Orzechowska A, Barcz E. Współczesne koncepcje etiopatogenezy zespołu policystycznych jajników. Ginekol Pol. 2007; 78: 393–399.
Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003; 88: 5957–5962.
Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med. 2006; 12: 324–332.
Nestler JE, Jakubowicz DJ, de Vargas AF, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab. 1998; 83: 2001–2005.
Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935; 29: 181–191.
Adams J, Franks S, Polson DW, Mason HD, Abdulwahid N, Tucker M, et al. Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet 1985; 8469–8470: 1375–1379.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81: 19–25.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004; 89: 2745–2749.
Skałba P. Zespół policystycznych jajników. In: Skałba P, editor. Endokrynologia ginekologiczna. Warszawa, PZWL, 1998. p. 289–298.
Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997; 18: 774–800.
Laven JSE, Mulders AGMGJ, van Santbrink, EJP, Eijkemans, MJC, Fauser, BCJM. PCOS: backgrounds, evidence and problems in diagnosing the syndrome. In: Slager E, Fauser B, van Geijn H, Brölmann H, Vervest H, editors. Gynaecology, obstetrics, and reproductive medicine in daily practice, Proceedings of the 15th Congress of Gynaecology, Obstetrics and Reproductive Medicine. International Congress Series 2005; 1279: 10–15.
Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989; 38: 1165–1174.
Bigos A, Pałkowska E, Rosołowska-Huszcz D. Effect of artificial and natural sweeteners on glucose and insulin in plasma of rats. JPCCR 2012; 6(2): 93–97.
Jakimiuk A, Czajkowski K. Brak owulacji i jajniki policystyczne. In: Speroff L, Fritz M, editors. Kliniczna endokrynologia ginekologiczna i niepłodność. Warszawa, Medipage, 2007. p 533–573.
Strączkowski M, Nikołajuk A, Dzienis-Strączkowska A. Metody pomiaru insulinooporności in vivo. In: Kinalska I, editor. Patofizjologia i następstwa kliniczne insulinooporności. Warszawa, WIG-Press, 2005: p. 215–217.
Sam S, Dunaif A. Polycystic ovary syndrome: syndrome XX? Trends Endocrinol Metab. 2003; 14: 365–370.
Kalme T, Koistinen H, Loukovaara M, Koistinen R, Leinonen PJ. Comparative studies on the regulation of insulin-like growth factor-binding protein-1 (IGFBP-1) and sex hormone-binding globulin (SHBG) production by insulin and insulin-like growth factors in human hepatoma cells. Steroid Biochem Mol Biol. 2003; 86: 197–200.
Castracane VD, Kauffman RP. Assessing insulin sensitivity. Contemporary OB/GYN 2003; 48(1): 30–35.
Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome – a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007; 92: 4546–4556.
Velazquez EM, Mendoza S, Hamer T, Sosa F, Glueck CJ. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism. 1994; 43: 647–654.
Kołodziejczyk B, Dulęba AJ, Spaczyński RZ, Pawelczyk L. Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome. Fertil Steril. 2000; 73: 1149–1154.
Gupta S, Chen D, O’Flynn O’Brien K, et al. Adolescent polycystic ovary syndrome: pathophysiology and implications of the disease. Arch Med Sci. 2009; 5(1A): S115-S131.
Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, et al. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab. 2007; 92: 2500–2505.
Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril. 2004; 82: 661–665.
Goodarzi MO, Azziz R. Diagnosis, epidemiology, and genetics of the polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2006; 20: 193–205.
Landay M, Huang A, Azziz R Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril. 2009; 92: 643–647.
Acién P, Quereda F, Matallín P, Villarroya E, López-Fernández JA, Acién M, Mauri M, Alfayate R. Insulin, androgens, and obesity in women with and without polycystic ovary syndrome: a heterogeneous group of disorders. Fertil Steril. 1999; 72: 32–40.
Balen A, Rajkowha M. Polycystic ovary syndrome – a systemic disorder? Best Pract Res Clin Obstet Gynaecol. 2003; 17: 263–274.
Saxena P, Prakash A, Nigam A. Efficacy of 2-hour post glucose insulin levels in predicting insulin resistance in polycystic ovarian syndrome with infertility. J Hum Reprod Sci. 2011; 4: 20–22.
Teede HJ, Hutchison SK, Zoungas S. The management of insulin resistance in polycystic ovary syndrome. Trends Endocrinol Metab. 2007; 18: 273–279.
Santana LF, de Sá MF, Ferriani RA, de Moura MD, Foss MC, dos Reis RM. Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome. Gynecol Endocrinol. 2004; 19: 88–96.
DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005; 83: 1454–1460.
Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1998; 83: 2694–2698.
Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010; 95: 2038–2049.
Abbas M, Gannon M. The use of metformin as first line treatment in polycystic ovary syndrome. Ir Med J. 2008; 101: 51–53.
Gupta S, Metterle L, Thakkar P, Surti N, Chandra A, Agarwal A. Ovulation induction in polycystic ovary syndrome. Arch Med Sci. 2009; 5(1A): 132–142.