Parker Jim, Briden Lara, Gersh Felice L
School of Medicine, University of Wollongong, Wollongong 2522, Australia.
Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
J Clin Med. 2025 Jun 6;14(12):4021. doi: 10.3390/jcm14124021.
Polycystic ovary syndrome (PCOS) is a common metabolic-endocrine disorder affecting women of reproductive age, and insulin resistance (IR) is a key pathophysiological feature. Current medical education and clinical practice emphasize glucose-centric approaches in PCOS management, and IR testing is often overlooked due to limited emphasis in current clinical guidelines or the lack of standardized protocols. Additionally, the glucose-focused paradigm has been the standard of care for decades. However, this approach has led to delayed diagnosis of progressive metabolic and reproductive consequences, leaving many patients underdiagnosed and undertreated. Therefore, we propose a paradigm shift towards an insulin-centric model for PCOS management. This new approach aims to diagnose IR at an earlier stage, enabling the timely implementation of effective lifestyle and treatment strategies. By focusing on IR, clinicians can potentially limit the progression of PCOS-related reproductive and metabolic diseases. The insulin-centric model is a novel approach that involves comprehensive IR screening, dynamic insulin testing, personalized lifestyle and insulin-sensitizing interventions, and regular monitoring of insulin and glycemic parameters. This model could improve patient outcomes by facilitating early diagnosis of metabolic dysfunction and reducing the incidence of subsequent chronic disease. Furthermore, this model has broader implications, potentially transforming treatment approaches for various chronic diseases beyond PCOS.
多囊卵巢综合征（PCOS）是一种影响育龄女性的常见代谢 - 内分泌紊乱疾病，胰岛素抵抗（IR）是其关键的病理生理特征。当前的医学教育和临床实践在PCOS管理中强调以葡萄糖为中心的方法，由于当前临床指南中对此强调有限或缺乏标准化方案，IR检测常常被忽视。此外，以葡萄糖为重点的模式几十年来一直是治疗标准。然而，这种方法导致了对渐进性代谢和生殖后果的诊断延迟，使许多患者未得到充分诊断和治疗。因此，我们提议将PCOS管理模式转向以胰岛素为中心的模式。这种新方法旨在更早阶段诊断IR，从而能够及时实施有效的生活方式和治疗策略。通过关注IR，临床医生有可能限制PCOS相关生殖和代谢疾病的进展。以胰岛素为中心的模式是一种新颖的方法，包括全面的IR筛查、动态胰岛素检测、个性化的生活方式和胰岛素增敏干预措施，以及定期监测胰岛素和血糖参数。该模式可通过促进代谢功能障碍的早期诊断和降低后续慢性病的发病率来改善患者预后。此外，该模式具有更广泛的意义，可能会改变PCOS以外各种慢性病的治疗方法。
