Pharmacotherapeutic management of comorbid polycystic ovary syndrome and diabetes

ABSTRACT

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in premenopausal women. Insulin resistance and glucose intolerance are very prevalent metabolic complications in women with PCOS, especially in those presenting with weight excess. Therapeutic strategies targeting insulin resistance in PCOS are of interest because of their overall safety and their beneficial effects on metabolic and reproductive features.

Areas covered: The authors review systematically all of the available therapeutic interventions targeting insulin resistance and/or disturbances of glucose metabolism in women with PCOS.

Expert opinion: The diagnosis of glucose tolerance disorders in women with PCOS requires an oral glucose tolerance test. Strategies addressing weight excess and abdominal adiposity, from lifestyle modification to insulin sensitizers, may improve insulin resistance and glucose tolerance in women with PCOS. However, amelioration of signs and symptoms of PCOS usually requires the loss of large amounts of weight for it to be noticeable. Bariatric surgery has emerged as the most successful approach for obese patients with PCOS, because glucose intolerance, diabetes, and PCOS resolve in most cases through follow-ups. At present, the role of novel drugs targeting insulin resistance and/or diabetes such as inositols, berberine, resveratrol, and incretin-based therapies are yet to be properly established.

KEYWORDS:

• Diabetes
• glucose intolerance
• insulin resistance
• insulin sensitizers
• metformin
• oral antidiabetic drugs
• polycystic ovary syndrome

Article highlights

• Most women with PCOS and weight excess and/or hyperandrogenemia present with reduced insulin sensitivity compared with their non-hyperandrogenic counterparts.

• Disorders of glucose tolerance, including prediabetes, type 2 diabetes, and gestational diabetes, are prevalent in women with PCOS.

• Lifestyle modification is the mainstay of therapy for insulin-resistant PCOS women.

• Benefits of bariatric surgery in PCOS patients are not only limited to weight loss, but extend to dermo-cosmetic, reproductive, and metabolic abnormalities.

• When added to lifestyle intervention, metformin is the drug of choice for the management of type 2 diabetes in women with PCOS and might be also considered in patients with prediabetes.

• GLP-1 receptor agonists may become a therapeutic alternative to metformin in obese PCOS women, although further confirmatory evidence is needed at present.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

The authors are supported by grants PI1400649, PI1501686, and PIE1600050 from Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness. CIBERDEM and IRYCIS are also initiatives of the Instituto de Salud Carlos III, which is supported in part by the Fondo Europeo de Desarrollo Regional FEDER.