Pani Arianna, Gironi Ilaria, Di Vieste Giacoma, Mion Elena, Bertuzzi Federico, Pintaudi Basilio
Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.
Diabetes Consultant, Milan, Italy.
Int J Endocrinol. 2020 Jun 8;2020:6276187. doi: 10.1155/2020/6276187. eCollection 2020.
Despite the very clear association between polycystic ovary syndrome (PCOS) and dysglycemia, few studies have explored the continuum of glycemic alterations leading from minor glucose abnormalities to overt diabetes. The purpose of this review is to trace the natural history of glycemic alteration in women with PCOS.
We performed a literature review without time limit until August 2019. Inclusion criteria were studies addressing the association between impaired glucose tolerance or impaired fasting glucose or type 2 diabetes (T2D) and PCOS with at least an English abstract. The exclusion criteria were no PCOS or impaired glucose tolerance or impaired fasting glucose or T2D as outcome. The outcomes of interest were the onset of impaired glucose tolerance, impaired fasting glucose, T2D, and the progression from impaired glucose tolerance or impaired fasting glucose to T2D.
Healthy diet and physical activity are the first-line therapy for PCOS. Treatment with metformin was associated with significant lower 2-hour postload glucose levels and with reduction in fasting glucose when compared to placebo. Thiazolidinediones were more effective in reducing fasting glucose levels compared to placebo. Metformin and pioglitazone treatments showed similar effects on fasting glucose levels. The sodium-glucose cotransporter-2 inhibitor empagliflozin did not show differences in metabolic parameters when compared to metformin. The combination therapy with metformin plus the glucagon-like peptide-1 receptor agonist liraglutide was associated with significant improvements in basal and postload glucose levels compared with only liraglutide. Likewise, a combination therapy with the dipeptidyl peptidase-4 inhibitor saxagliptin and metformin demonstrated superiority versus metformin in fasting glucose and oral glucose tolerance test normalization. Myo-inositol supplementation was associated with lower insulin levels, glucose levels, and insulin resistance when compared with placebo, metformin, or estrogen treatments.
The use of insulin-sensitizing agents, such as metformin and inositols, along with lifestyle interventions may improve the metabolic profile in PCOS women.
尽管多囊卵巢综合征（PCOS）与血糖异常之间的关联非常明确，但很少有研究探讨从轻微血糖异常到显性糖尿病的血糖改变连续过程。本综述的目的是追踪PCOS女性血糖改变的自然病程。
我们进行了一项无时间限制的文献综述，截至2019年8月。纳入标准为至少有英文摘要、探讨葡萄糖耐量受损或空腹血糖受损或2型糖尿病（T2D）与PCOS之间关联的研究。排除标准为未将PCOS或葡萄糖耐量受损或空腹血糖受损或T2D作为结局。感兴趣的结局为葡萄糖耐量受损、空腹血糖受损、T2D的发病，以及从葡萄糖耐量受损或空腹血糖受损进展为T2D。
健康饮食和体育活动是PCOS的一线治疗方法。与安慰剂相比，二甲双胍治疗可使负荷后2小时血糖水平显著降低，并使空腹血糖降低。与安慰剂相比，噻唑烷二酮类药物在降低空腹血糖水平方面更有效。二甲双胍和吡格列酮治疗对空腹血糖水平的影响相似。与二甲双胍相比，钠-葡萄糖协同转运蛋白2抑制剂恩格列净在代谢参数方面未显示出差异。与仅使用利拉鲁肽相比，二甲双胍联合胰高血糖素样肽1受体激动剂利拉鲁肽的联合治疗可使基础血糖和负荷后血糖水平显著改善。同样，二肽基肽酶4抑制剂沙格列汀与二甲双胍的联合治疗在空腹血糖正常化和口服葡萄糖耐量试验方面优于二甲双胍。与安慰剂、二甲双胍或雌激素治疗相比，补充肌醇与较低的胰岛素水平、血糖水平和胰岛素抵抗相关。
使用胰岛素增敏剂，如二甲双胍和肌醇，以及生活方式干预，可能改善PCOS女性的代谢状况。
