DEALING WITH INSULIN RESISTANCE AMONG WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

U AZIZ; M AFZAL; RT YOUSAF; S  IMRAN; T SARFRAZ; HR JAVED; W SULTAN

doi:10.54112/bcsrj.v2023i1.276

Authors

U AZIZ Department of Obs and Gynae, Rashid Latif Medical Complex, Arif Memorial Teaching Hospital Lahore, Pakistan
M AFZAL Department of Obs and Gynae, Rashid Latif Medical Complex, Arif Memorial Teaching Hospital Lahore, Pakistan
RT YOUSAF Department of Obs and Gynae, University College of Medicine and Dentistry Lahore, Pakistan
S IMRAN Department of Obs and Gynae, Hameed Latif Hospital Lahore, Pakistan
T SARFRAZ Department of Obs and Gynae, University of Lahore, Pakistan
HR JAVED Ddepartment of Physical Therapy, Sahiwal International Hospital, Pakistan
W SULTAN Department of Nutritionist & Dietitian, Sahiwal International Hospital, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.276

Keywords:

Hyperinsulinemia, metformin, lifestyle modification, Polycystic ovarian syndrome

Abstract

One of the most prevalent endocrine disorders in females, polycystic ovarian syndrome (PCOS), affects about 7-8% of women of reproductive age. Most females with PCOS also have increased cholesterol levels, insulin resistance, and BMI, leading to obesity. The study aimed to determine the effects of metformin and lifestyle modification (diet & exercise) on insulin resistance secondary to PCOS after 6 months of use. This RCT study was conducted at Arif Memorial Teaching Hospital from October 2022 to March 2023. The study compared the effects of metformin and lifestyle management, including only a diet plan with the use of metformin diet and exercise plan, on insulin resistance in 130 obese females aged between 20-40 years suffering from PCOS and had insulin resistance as diagnosed by HBA1C blood test. The main outcome measure was the reduction in the HBA1C level. The 130 participants were equally divided into two groups. Group A received metformin only, while Group B received metformin and an exercise plan. Baseline treatment included guidance to adopt a healthy diet. The results showed significant improvement in HBA1C level (P=0.00), BMI (P=0.02), and pregnancy rate. There was an overall improvement in the menstrual pattern but a significant improvement in Group B (P=0.00) than Group A (P=0.06). With a significant rise in follicle-stimulating hormone (FSH) levels in both groups [P=0.06 (A), P=0.01(B)], a statistically significant decrease in luteinizing hormone (LH) [P=0.02 (A), P=0.01(B)] was seen. A total drop in free testosterone level was also seen, but it wasn't significant [P=0.08 (A), P=0.06 (B)]. The study concluded that insulin resistance could be controlled effectively by acquiring a healthy lifestyle, including high protein and low carb, caloric deficient diet, and following an exercise plan and pharmacological treatment. Combining all three treatment options is more effective than using any one option as treatment.

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References

Artani, M., et al. (2018). "Effects of metformin on symptoms of polycystic ovarian syndrome among women of reproductive age." 10(8).

Aruna, J., et al. (2004). "Metformin therapy in women with polycystic ovary syndrome." 87(3): 237-241.

Azziz, R., et al. (2016). "Polycystic ovary syndrome." 2(1): 1-18.

Azziz, R. J. O. and Gynecology (2018). "Polycystic ovary syndrome." 132(2): 321-336.

Barry, J. A., et al. (2014). "Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis." 20(5): 748-758.

Cai, X., et al. (2014). "Association between fat mass-and obesity-associated (FTO) gene polymorphism and polycystic ovary syndrome: a meta-analysis." 9(1): e86972.

Chen, H. and C. E. D. Lim (2019). "The efficacy of using acupuncture in managing polycystic ovarian syndrome." 31(6): 428-432.

Dumesic, D. A., et al. (2020). "Endocrine–metabolic dysfunction in polycystic ovary syndrome: An evolutionary perspective." 12: 41-48.

Dumesic, D. A., et al. (2015). "Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome." 36(5): 487-525.

Farshchi, H., et al. (2007). "Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management." 27(8): 762-773.

Galluzzo, A., et al. (2008). "Insulin resistance and polycystic ovary syndrome." 18(7): 511-518.

Glintborg, D. and M. J. G. e. Andersen (2010). "An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome." 26(4): 281-296.

Goodman, N. F., et al. (2015). "American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1." 21(11): 1291-1300.

Gunning, M. N., et al. (2020). "Cardiometabolic health in offspring of women with PCOS compared to healthy controls: a systematic review and individual participant data meta-analysis." 26(1): 104-118.

Ndefo, U. A., et al. (2013). "Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches." 38(6): 336.

Nybacka, Å., et al. (2011). "Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome." 96(6): 1508-1513.

Pastore, L. M., et al. (2011). "Depression symptoms and body dissatisfaction association among polycystic ovary syndrome women." 71(4): 270-276.

Patil, S. P., et al. (2035). "Yoga for holistic treatment of polycystic ovarian syndrome." 10(S 2).

Sidra, S., et al. (2019). "Evaluation of clinical manifestations, health risks, and quality of life among women with polycystic ovary syndrome." 14(10): e0223329.

Stener‐Victorin, E., et al. (2016). "Changes in HbA1c and circulating and adipose tissue androgen levels in overweight‐obese women with polycystic ovary syndrome in response to electro-acupuncture." 2(4): 426-435.

Teede, H., et al. (2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan." 8(1): 1-10.

Tsilchorozidou, T., et al. (2004). "The pathophysiology of polycystic ovary syndrome." 60(1): 1-17.

Tummon, I., et al. (2005). "Polycystic ovaries and ovarian hyperstimulation syndrome: a systematic review." 84(7): 611-616.

Wang, Y., et al. (2022). "Research Trends of Acupuncture Therapy on Polycystic Ovary Syndrome: A Bibliometric Analysis." Evidence-Based Complementary and Alternative Medicine 2022: 1989401.

Zulfiqar, S., et al. (2022). "Investigation of Prevalence and Awareness of Polycystic Ovary Syndrome among Pakistani Females: Polycystic Ovary Syndrome in Pakistani Women." 59(1): 77-83.