Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta‐analysis
Open accessAbstract
Objective: Characteristic features of polycystic ovary syndrome (PCOS) include insulin resistance and an increased risk for type 2 diabetes. To promote improved insulin sensitivity, insulin sensitisers have been used in PCOS. However, direct comparisons across these agents are limited. This study compared the effects of metformin, rosiglitazone and pioglitazone in the management of PCOS to inform the 2023 International Evidence‐based PCOS Guideline. Design: Systematic review and meta‐analysis of the literature. Patients: Women with PCOS and treatment with insulin sensitisers. Measurements: Hormonal and clinical outcomes, as well as side effects. Results: Of 1660 publications identified, 13 randomised controlled trials were included. Metformin was superior in lowering weight (mean difference [MD]: −4.39, 95% confidence interval [CI]: −7.69 to −1.08 kg), body mass index (MD: −0.95, 95% CI: −1.41 to −0.49 kg/m 2) and testosterone (MD: −0.10, 95% CI: −0.18 to −0.03 nmol/L) versus rosiglitazone, whereas there was no difference when comparing metformin to pioglitazone. Adding rosiglitazone or pioglitazone to metformin did not improve metabolic outcomes. However, rosiglitazone seemed superior to metformin in lowering lipid concentrations. Conclusions: Metformin should remain the first‐line insulin sensitising treatment in adults with PCOS for the prevention and management of weight and metabolic features. The addition of thiazolidinediones appears to offer little benefit.
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Metformin improves ovulation and enhances insulin sensitivity, and is the first-line insulin-sensitizing medication used to treat PCOS.
“Metformin, which improves ovulation and enhances insulin sensitivity, is the first-line insulin-sensitizing medication used to treat PCOS; it was used as a treatment drug in the control group in this study [15].”
From Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial (2024) · cites this paper as [15]
The Abstract recommends metformin as the first-line insulin-sensitising treatment for adults with PCOS, specifically for weight and metabolic features. The Discussion says metformin is indicated for ovulation induction, though it is less effective than conventional ovulation-induction therapy. The claim omits those limits and presents first-line use as applying to PCOS treatment generally. (LLM, conf=0.85)
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Dilimulati, D., Shao, X., Wang, L., Cai, M., Zhang, Y., Lu, J., Wang, Y., Liu, H., Kuang, M., Chen, H., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/55883 · Cited by 17 · see citing works
“Metformin, which improves ovulation and enhances insulin sensitivity, is the first-line insulin-sensitizing medication used to treat PCOS; it was used as a treatment drug in the control group in this study [15].”
- Authors
- Melin, J. M., Forslund, M., Alesi, S. J., Piltonen, T., Romualdi, D., Spritzer, P. M., Tay, C. T., Pena, A. S., Witchel, S. F., Mousa, A., & Teede, H. J.
- Affiliations
- University of Helsinki (FI)
- Monash University (AU)
- Oulu University Hospital (FI)
- Agostino Gemelli University Polyclinic (IT)
- Universidade Federal do Rio Grande do Sul (BR)
- Discipline of Paediatrics The University of Adelaide and Robinson Research Institute North Adelaide South Australia Australia
- University of Pittsburgh (US)
- Monash Health (AU)
- Corresponding author
- Melin, Johanna M.
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2023-11-07
- Volume
- 100
- Issue
- 2
- Pages
- 149-163
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W4388454884
- Cited by
- 16
- References
- 15
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 9
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- National Health and Medical Research Council
- RACP Foundation
- Novo Nordisk
- Academy of Finland
- Stiftelsen Handlanden Hjalmar Svenssons
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
- Keywords
- polycystic ovary syndrome, metformin, rosiglitazone, pioglitazone, thiazolidinediones, insulin resistance, weight loss, body mass index, testosterone, serum lipids, type 2 diabetes prevention, first-line therapy
- MeSH terms
- Rosiglitazone, Pioglitazone, Adult, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Insulin, Insulin Resistance, Metformin, Polycystic Ovary Syndrome, Thiazolidinediones
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