Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School (HYMS), The University of Hull, Hull, UK.
Biotechnology Research Centre, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Clin Endocrinol (Oxf). 2022 Mar;96(3):371-394. doi: 10.1111/cen.14623. Epub 2021 Oct 29.
Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterized by insulin resistance and is a major risk factor for type 2 diabetes mellitus (T2DM). The objective was to review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS.
We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-ana. Reviwers extracted data and assessed the risk of bias using the Cochrane risk of bias tool.
In 58 randomized controlled trials there were significant reductions in the fasting blood glucose (FBG) with metformin versus placebo (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.40, -0.06; I² = 0%, low-grade evidence), and acarbose versus metformin (mean difference [MD]: -10.50 mg/dl; 95% CI: -15.76, -5.24; I² = 0%, low-grade evidence). Significant reductions in fasting insulin (FI) with pioglitazone versus placebo (SMD: -0.55; 95% CI: -1.03, -0.07; I² = 37%; p = .02, very-low-grade evidence). A significant reduction in homoeostatic model assessment of insulin resistance (HOMA-IR) was seen with exenatide versus metformin (MD: -0.34; 95% CI: -0.65, -0.03; I² = 0%, low-grade evidence). No effect on homoeostatic model assessment of beta cells (HOMA-B) was observed.
Pharmacological interventions, including metformin, acarbose, pioglitazone and exenatide have significant effects on FBG, FI, HOMA-IR but not on HOMA-B.
多囊卵巢综合征（PCOS）是一种影响育龄妇女的复杂内分泌疾病。它的特征是胰岛素抵抗，是 2 型糖尿病（T2DM）的主要危险因素。目的是回顾不同药物干预对 PCOS 妇女胰岛素抵抗影响的文献。
我们于 2020 年 4 月检索了 PubMed、MEDLINE、Scopus、Embase、Cochrane 图书馆和 Web of Science，并于 2021 年 3 月进行了更新。本研究遵循 2020 年系统评价和 Meta 分析首选报告项目。研究人员使用 Cochrane 偏倚风险工具提取数据并评估偏倚风险。
在 58 项随机对照试验中，与安慰剂相比，二甲双胍显著降低空腹血糖（FBG）（标准化均数差 [SMD]：-0.23；95%置信区间 [CI]：-0.40，-0.06；I²=0%，低质量证据），阿卡波糖与二甲双胍相比（平均差值 [MD]：-10.50mg/dl；95%CI：-15.76，-5.24；I²=0%，低质量证据）。与安慰剂相比，吡格列酮显著降低空腹胰岛素（FI）（SMD：-0.55；95%CI：-1.03，-0.07；I²=37%；p=0.02，极低质量证据）。与二甲双胍相比，艾塞那肽显著降低稳态模型评估的胰岛素抵抗（HOMA-IR）（MD：-0.34；95%CI：-0.65，-0.03；I²=0%，低质量证据）。对稳态模型评估的胰岛β细胞（HOMA-B）无影响。
药物干预，包括二甲双胍、阿卡波糖、吡格列酮和艾塞那肽，对 FBG、FI、HOMA-IR 有显著影响，但对 HOMA-B 无影响。
