DEALING WITH INSULIN RESISTANCE AMONG POLYCYSTIC OVARIAN SYNDROME PATIENT
Main Article Content
Keywords
Poly-cystic Ovarian Syndrome, PCOS, Insulin Resistance, Lifestyle Modification, Lipid Profile
Abstract
Background: Insulin resistance is a key factor in the pathophysiology of PCOS and is associated with various metabolic complications, including type II diabetes, obesity, and cardiovascular diseases.
Objective: The objective of this study is to evaluate effectiveness of multimodal treatment for managing insulin resistance in patients with Polycystic Ovarian Syndrome
Methodology: It is a randomized control study conducted at Sandeman Provincial Hospital Quetta from 1st May 2023 to 30th April 2024. 100 participants received tablet Metformin 500mg thrice a day along with a low calorie diet and exercise plan. Participant were treated for 3 months and their BMI, caloric intake, serum FSH, LH, testosterone, fasting blood glucose and fasting insulin levels were measured. The data analysis was conducted using the Statistical Package for Social Sciences version 24.00. The p value of ≤ 0.5 was considered significant.
Result: The average age of participants was 26.78±6.54years. There was reduction in BMI from 30.13±5.41 to 26.2±2.9, Homeostasis Model Assessment of Insulin Resistance decreased significantly from 4.2±0.8 to 2.1±0.5, with FSH increasing from 5.1±1.7U/L to 7.9±2.8U/L(P = 0.02) and LH decreasing from 9.2±5.5U/L to 6.5±1.7U/L(P= 0.02), indicating improved ovarian function and hormonal balance. Total testosterone levels also decreased from 76.3±12.4 pg/ml to 63.8±9.7pg/ml. menstrual regularity and ovulation restoration was observed in 71% and 59% of participants respectively.
Conclusion: Comprehensive management strategies integrating dietary adjustments, regular physical activity, and pharmacological treatment are foundational in enhancing insulin sensitivity and mitigating risks such as menstrual irregularities and hyper-androgenism in patients with Polycystic Ovarian Syndrome.
References
2. Bilal M, Khadija S, Arshad N, Saleem S. Among The Largest Population Which Age Group is the Most Having Polycystic Ovarian Syndrome. Saudi J Med. 2022. https://doi.org/10.36348/sjm.2022.v07i01.007.
3. Costello M, Misso M, Balen A, Boyle J, Devoto L, et al. A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome. Aust N Z J Obstet Gynaecol. 2019. https://doi.org/10.1111/ajo.13051.
4. Sha T, Wang X, Cheng W, Yan Y. A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod Biomed Online. 2019. https://doi.org/10.1016/J.RBMO.2019.03.203.
5. Kim J, Hwang K, Oh S, Chae S, Yoon S, Choi Y. Prevalence of insulin resistance in Korean women with polycystic ovary syndrome according to various homeostasis model assessment for insulin resistance cutoff values. Fertil Steril. 2019. https://doi.org/10.1016/j.fertnstert.2019.06.035.
6. Sharif Y. Serum leptin level-insulin resistance-based correlation in polycystic ovary syndrome obese and non-obese sufferer female. J Popul Ther Clin Pharmacol. 2022;29(2):e11-e19. https://doi.org/10.47750/jptcp.2022.916.
7. Yang Y, Zhou W, Wu S, Tang W, Wang Z, et al. Intestinal flora is a key factor in insulin resistance and contributes to the development of polycystic ovary syndrome. Endocrinology. 2021;162. https://doi.org/10.1210/endocr/bqab118.
8. Zhao J, Huang J, Geng X, Chu W, Li S, et al. Polycystic ovary syndrome: Novel and hub lncRNAs in the insulin resistance-associated lncRNA–mRNA network. Front Genet. 2019;10. https://doi.org/10.3389/fgene.2019.00772.
9. Rimmer M, Tan B, Teede H, Thangaratinam S, Wattar B. Metabolic inflexibility in women with polycystic ovary syndrome: A systematic review. Gynecol Endocrinol. 2019;36:501-507. https://doi.org/10.1080/09513590.2019.1698025.
10. Biernacka-Bartnik A, Kocełak P, Owczarek A, Choręza P, Markuszewski L, et al. The cut-off value for HOMA-IR discriminating the insulin resistance based on the SHBG level in women with polycystic ovary syndrome. Front Med. 2023;10. https://doi.org/10.3389/fmed.2023.1100547.
11. Moghetti P, Tosi F. Insulin resistance and PCOS: chicken or egg?. J Endocrinol Invest. 2021;44(2):233-244.
12. Xu Y, Qiao J. Association of insulin resistance and elevated androgen levels with polycystic ovarian syndrome (PCOS): A review of literature. J Healthc Eng. 2022;2022(1):9240569.
13. Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: An update. World J Diabetes. 2022;13(3):129.
14. Shang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metab. 2020;105(10):3346-3360.
15. Deshmukh H, Papageorgiou M, Wells L, Akbar S, Strudwick T, et al. The effect of a very-low-calorie diet (VLCD) vs. a moderate energy deficit diet in obese women with polycystic ovary syndrome (PCOS)—A randomised controlled trial. Nutrients. 2023;15. https://doi.org/10.3390/nu15183872.
16. Khalil N, Farahat T, Shaheen H, Fathey A, Mohammed A, Alkalash S et al. Effect of diet and exercise program on clinical and metabolic features of polycystic ovarian syndrome. Menoufia Med J. 2022;35:1162-1169. https://doi.org/10.4103/mmj.mmj_181_22.
17. Jungari M, Choudhary A, Gill N. Comprehensive management of polycystic ovary syndrome: Effect of pharmacotherapy, lifestyle modification, and enhanced adherence counseling. Cureus. 2023;15. https://doi.org/10.7759/cureus.35415.
18. Armanini D, Boscaro M, Bordin L, Sabbadin C. Controversies in the pathogenesis, diagnosis and treatment of PCOS: Focus on insulin resistance, inflammation, and hyperandrogenism. Int J Mol Sci. 2022;23(8):4110. https://doi.org/10.3390/ijms23084110.
19. Purwar A, Nagpure S. Insulin resistance in polycystic ovarian syndrome. Cureus. 2022;14(10):e153.
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Dr Firdous Ara
Associate Professor, OBG Unit 1, BMC, Sandeman Provincial Hospital, Quetta - Pakistan
Dr Maryam Shoaib
Associate Professor, OBG Unit 1, Sandeman Provincial Hospital, Quetta - Pakistan
Dr Rizwana Naz
Senior Registrar, Sandeman Provincial Hospital, Quetta - Pakistan
Dr Sadia Ghilzai
Consultant Gynaecologist, Sandeman Provincial Hospital, Quetta - Pakistan
Dr Saira Qadar
Consultant Gynaecologist, Sandeman Provincial Hospital, Quetta - Pakistan
Dr Sadiq Jan
Associate Professor, Islamic International Medical College, Rawalpindi - Pakistan