Metformin metabolic and vascular effects in overweight/moderately obese hyperinsulinemic PCOS patients treated with contraceptive vaginal ring: a pilot study

Abstract

The aim of this pilot study was to assess how metformin, associated with a contraceptive vaginal ring, may influence lipid and carbohydrate metabolism, fat distribution, and surrogate markers of arterial function. Among 62 patients, 25 were treated with vaginal ring plus metformin and 37 women with only vaginal ring. The effects were assessed after 6 months. The patients were submitted to evaluation of lipid and carbohydrate metabolism; extended view ultrasonographic evaluation of fat distribution; Doppler analysis of ophthalmic artery; brachial artery flow-mediated vasodilatation; oral glucose tolerance test. After 6 months, the body mass index and waist/hip ratio resulted significantly better in patients who associated metformin to vaginal ring. The fasting glucose, insulin, and glucose/insulin ratio, HOMA-IR, glucose, and insulin AUC 120 were significantly improved in metformin group. The ultrasonographic fat analysis resulted significantly better after metformin. The ophthalmic artery PI significantly improved in metformin group. The brachial artery vasodilation was better in metformin treated patients. In conclusion, metformin, associated with vaginal ring, improves the insulin and carbohydrate metabolism, reduces the body weight and android fat distribution. This, associated with the significant improvements of surrogate markers of arterial function, may be responsible of possible cardiovascular and cerebrovascular protective effects.

摘要

这项初步研究的目的是评估在阴道避孕环治疗情况下应用二甲双胍对患者脂类和碳水化合物代谢、脂肪分布以及动脉功能替代标记物的影响。62例患者中25例应用阴道避孕环联合二甲双胍治疗, 37例单独应用阴道避孕环治疗, 治疗6个月后进行评估。对患者进行脂类和碳水化合物代谢评估；应用扩展视野超声评估脂肪分布；眼动脉多普勒分析；肱动脉血流介导的血管扩张功能；口服葡萄糖耐量试验。6个月后二甲双胍与阴道环联合组患者的体重指数和腰/臀比显著改善。二甲双胍组空腹血糖、胰岛素和血糖/胰岛素比值、胰岛素抵抗指数（HOMA-IR）、血糖和120分钟胰岛素分泌显著改善。二甲双胍治疗后超声显示脂肪分析结果明显好转。二甲双胍组眼动脉PI明显改善。二甲双胍治疗组肱动脉扩张效果较好。总之, 二甲双胍与阴道避孕环联合应用改善胰岛素和碳水化合物代谢, 减轻体重和男性型脂肪分布。动脉功能替代标记物的显著改善可能与心血管和脑血管保护作用有关。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Metformin
• PCOS
• contraception
• insulin
• vascular risk

Disclosure statement

No potential conflict of interest was reported by the authors.