The frequency of insulin resistance calculated upon the basis of a fasting glucose to insulin ratio and characteristics of insulin resistant women with polycystic ovary syndrome.

BACKGROUND: The Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disorder of women of reproductive age, characterized by hyperandrogenism and chronic anovulation. Peripheral insulin resistance (IR) has a crucial role in the pathogenesis of this disorder. A fasting glucose to insulin (G/I) ratio is a simple, reliable, sensitive and specific measurement of insulin sensitivity and is a useful test for the identification of IR in women with PCOS, who have to be treated with insulin sensitizers. OBJECTIVE: To calculate the frequency of IR among patients with PCOS, using the fasting G/I ratio, and to compare the clinical and biochemical parameters between insulin-resistant and insulin-sensitive groups. PATIENTS AND METHODS: The study comprised 62 patients of reproductive age (18-40) with PCOS. The diagnosis PCOS was determined according to the diagnostic criteria from Rotterdam 2003, i.e. the presence of two of the following three criteria: oligo-ovulation and/or anovulation; clinical and/or biochemical hyperandrogenism; and polycystic ovaries. All other states associated with hyperandrogenism had been previously excluded. An inclusion criterion for the study was the body mass index (BMI) >or=25 (kg/m2). After calculating the fasting glucose(mg/dl) / insulin(microU/ml) ratio, the patients were separated in two groups, i.e. an insulin-resistant group with a fasting G/I ratio of < 4.5(mg/10(-4) U) and an insulin-sensitive group with a fasting G/I ratio of >/=4.5(mg/10(-4) U). RESULTS: In our study, 58.06% of women with PCOS and BMI >or=25 (kg/m2) were insulin-resistant. There was no significant difference between the two groups in age or BMI. Sex hormone binding globulin (SHBG) levels were significantly lower in the insulin-resistant group (17.83 +/- 8.38 vs. 42.66 +/- 27.65 (nmol/l); p=0.0036) and they had a higher free testosterone index (19.38 +/- 8.91 vs. 9.55 +/-3.51(%); p=0.001) in comparison with the insulin-sensitive group. Progesterone levels were significantly lower in the IR group (2.41 +/- 2.50 vs. 7.05 +/- 8.04 (ng/ml); p=0.034). CONCLUSION: A fasting glucose to insulin ratio is a simple and useful test for identifying insulin-resistant obese women with PCOS. SHBG and progesterone (oligo-ovulation/anovulation) can be useful markers for long-term health risks in women with PCOS (diabetes mellitus type 2 and cardiovascular diseases). In this way we could identify the group of PCOS subjects and its subgroups, which would benefit from therapy with insulin sensitizers, with respect to the reduction of risks of chronic complications.

Metformin improves menstrual patterns, endocrine and metabolic profile in obese hyperinsulinemic women with a polycystic ovary syndrome.

OBJECTIVE: To evaluate the therapeutic effect of metformin on the clinical features, hormonal and metabolic profile in obese women with a hyperinsulinemic polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: We analyzed 25 women with PCOS, mean age 27.28+/-7.85 years, BMI 34.42+/-6.61 kg/m2, FerrimanGallwey (F/G) score 17.43+/-5.45 and duration of menstrual cycle 79.2 +/- 54.5 days. Basal hormone measurements included: FSH, LH, total testosterone, DHEAS, 17 alpha OHP and E2. All patients underwent a 75 g oral glucose tolerance test (OGTT), during which fasting and stimulated levels of glucose and insulin were measured at 0', 60' and 120'. The lipid profile was also performed. Both basal and stimulated parameters were analyzed before and after treatment with metformin (500 mg orally, three times daily for 9 months). RESULTS: After metformin treatment the mean frequency of menses became significantly more regular (79.2+/-54.5 days vs. 31.61 +/-7.7 days, P<0.01) and mean testosterone level had significantly decreased (2.78+/-1.23 vs. 1.72+/-0.95 ng/ml, (P<0.01). We also observed a statistically significant decrease in the metabolic parameters, both basal insulinemia (22.18 +/- 5.76 vs. 17.19+/-6.67 microU/ml, P<0.01), stimulated insulinemia after 60' (179.18+/-88.96 vs. 136.38+/-75.43 microU/ml, P=0.04), stimulated insulinemia after 120' (163.23 +/-89.2 vs. 88.46 +/- 61.5 U/ml, P<0.01) and glucose response to OGTT on 120' (7.07 +/- 1.82 vs. 6.15 +/-1.52 mmol/L, P=0.04). The levels of HDL cholesterol had increased (0.94+/-0.16 vs. 1.13+/-0.19 mmol/L, P=0.04). No changes were noted on the hirsutism score and other steroid levels. CONCLUSION: In women with PCOS treatment with metformin is effective in the lowering of hyperinsulinemia and hyperandrogenemia. In most women metformin improves the menstrual pattern, but has no effect on hirsutism.