Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Abstract

Objective: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.

Methods: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.

Results: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07?±?2.44 versus 2.08?±?1.12; p?=?0.001) and fasting insulin (16.76?±?8.63?µIU/L versus 10.15?±?5.07?µIU/L; p?=?0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74–0.84) with optimum cut-off value of 2.92 (sensitivity?=?63.5%; specificity?=?89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p?=?0.02) and Cesarean section (p?=?0.04) in GDM mothers.

Conclusions: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.     

糖代谢异常孕妇胰岛素抵抗程度与巨大儿的关系

目的探讨糖代谢异常孕妇中胰岛素抵抗（IR）和胰岛β细胞功能的关系,以及胰岛素抵抗程度与巨大儿发生的关系。方法测定35例妊娠期糖耐量异常孕妇（GIGT）和12例妊娠期糖尿病孕妇（GDM）的空腹血糖、胰岛素,采用稳态模型评估法（HOMA）计算GIGT和GDM的胰岛素抵抗指数（HOMA-IR）和胰岛β细胞功能指数（HBCI）。结果GIGT、GDM两组孕妇HBCI无统计学差异（P〉0.05）,而HOMA-IR差异有统计学意义（P〈0.05）;HOMA-IR与巨大胎儿的发生没有显著相关性。结论GDM较GIGT孕妇存在更为明显的胰岛素抵抗,没有发现胰岛素抵抗指数与巨大儿的发生相关。     

One-hour post-glucola results and pre-pregnancy body mass index are associated with the need for insulin therapy in women with gestational diabetes

Objective.?The purpose of this study was to analyze the relationship of 1-h post-glucola (PG) screening results and the need for insulin therapy in women with gestational diabetes (GDM).

Methods.?The study group was comprised of women with GDM treated at a single institution during calendar years 2000–2004. Women with singleton, term (≥37 weeks gestation), liveborn fetuses were included. The association of 1-h PG results and other perinatal risk factors to the need for subsequent insulin therapy was analyzed using multivariable logistic regression models.

Results.?Of the 1451 women were included in the analysis, 18.1% required insulin treatment. The mean 1-h PG result was 170.0?±?26.1?mg/dl (range 140–414?mg/dl). We determined that a 1-h PG?≥?190?mg/dl (p?<?0.0001), an obese body mass index (BMI) (p?<?0.0001), an overweight BMI (p?=?0.0019), prior GDM (p?=?0.0019), and prior macrosomia (p?=?0.0210) were each highly associated with the need for subsequent insulin therapy during the pregnancy.

Conclusions.?A 1-h PG?≥?190?mg/dl was strongly associated with the need for insulin therapy in women with GDM. These data may be helpful in counseling and managing women with GDM.     

妊娠糖尿病胰岛素治疗与围生儿预后

目的 探讨在妊娠糖尿病（GDM）治疗中胰岛素、饮食以及开始治疗时间早晚对围生儿预后的影响。方法 选择诊断为妊娠糖尿病者109例，其中采用饮食加胰岛素治疗22例，单纯饮食控制组低于应用胰岛素组，差异显著（P＜0.05）。围生儿结局显示：巨大儿发生率、红细胞增多症发生率三组为34周后饮食控制组＞34周前饮食控制组＞胰岛素治疗组。结论 GDM要早诊断、早治疗，尤其是应用胰岛素正规治疗对降低围生儿病率、巨大发生率以及控制孕妇血糖水平有重要意义。     

The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy

Abstract

Low serum vitamin D levels are correlated with insulin resistance during pregnancy. We have assessed the effects of different doses of vitamin D on insulin resistance during pregnancy. A randomized clinical trial was done on 120 women with a gestational age of less than 12 weeks. The women were divided into three groups randomly. Group A received 200?IU vitamin D daily, group B 50?000?IU vitamin D monthly and group C 50?000?IU vitamin D every 2 weeks from 12 weeks of pregnancy until delivery. The serum levels of fasting blood sugar (FBS), insulin, calcium and 25-hydroxyvitamin D were measured before and after intervention. We used the homeostatic model assessment of insulin resistance (HOMA-IR) as a surrogate measure of insulin resistance. The mean?±?standard deviation of serum 25-hydroxyvitamin D increased in group C from 7.3?±?5.9 to 34.1?±?11.5?ng/ml and in group B it increased from 7.3?±?5.3 to 27.23?±?10.7?ng/ml, but the level of vitamin D in group A increased from 8.3?±?7.8 to 17.7?±?9.3?ng/ml (p?<?0.001). The mean differences of insulin and HOMA-IR before and after intervention in groups A and C were significant (p?=?0.01, p?=?0.02). This study has shown that supplementation of pregnant women with 50?000?IU vitamin D every 2 weeks improved insulin resistance significantly.     

Elevated concentrations of retinol-binding protein-4 (RBP-4) in gestational diabetes mellitus: Negative correlation with soluble vascular cell adhesion molecule-1 (sVCAM-1)

Background. Retinol-binding protein-4 (RBP-4) may increase insulin resistance (IR) in animals, with elevated levels reported in humans with obesity and type 2 diabetes. There are, however, few data on concentrations of RBP-4 in gestational diabetes mellitus (GDM).

Methods. We measured fasting serum levels of RBP-4, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in 50 women at 28 weeks of gestation, divided according to the results of a 50 g glucose challenge test (GCT) and a 75 g oral glucose tolerance test (OGTT): (1) controls (n = 20), normal responses to both GCT and OGTT; (2) intermediate group (IG) (n = 15): false positive GCT, but normal OGTT; and (3) GDM group (n = 15), both GCT and OGTT abnormal. IR was assessed by homeostasis model assessment (HOMA-IR) and by insulin resistance index (IRI) based on glycemia and insulinemia during OGTT.

Results. All groups were matched for age and body mass index (BMI). RBP-4 levels (μg/ml, mean±standard deviation) were higher in women with GDM vs. controls (53.9 ± 17.9 vs. 29.7 ± 13.9, p ≤ 0.001), with a trend towards higher RBP-4 in GDM compared with IG (38.0 ± 19.3, p = 0.07). There was no significant correlation between RBP-4 and age, BMI, insulin, IRI or HOMA-IR, but there was a moderate, significant negative correlation between RBP-4 and sVCAM-1 (r² = 0.20, p = 0.001).

Conclusions. RBP-4 levels are elevated in women with GDM, but do not correlate with IR indices and correlate negatively with sVCAM-1. The physiological significance of RBP-4 rise in women with GDM remains to be elucidated.     

Exercise Fails to Improve Postprandial Glycemic Excursion in Women with Gestational Diabetes

The effect of an acute period of moderate intensity exercise on maternal glycemic excursion following a mixed nutrient meal was studied. Five normal (NL) and six gestational diabetic (GDM) subjects were enrolled. A randomized crossover design was used to compare fasting glucose and insulin levels, peak glucose and insulin levels and incremental area of the glycemic and insulin curves following a mixed nutrient meal with or without an exercise stress that took place 14 h earlier. Exercise consisted of upright stationary cycling for 30 min at a heart rate consistent with 60% O_{2 max}. The clinical characteristics of normal and gestational diabetic subjects were comparable. Mean values (±SM) with, versus without, exercise for fasting glucose (NL: 78.9 ± 2.6 vs. 80.0 ± 2.6 mg/dl; GDM: 86.4 ± 2.0 vs. 82.1 ± 3.5 mg/ dl), peak glucose (NL: 132.3 ± 10.4 vs. 139.1 ± 15.6 mg/dl; GDM: 165.8 ± 5.5 vs. 160.3 ± 7.8 mg/dl), the area under the glycemic curve (NL: 5758 ± 1038 vs. 6393 ± 1281 mg/dl ± min; GDM: 8,178 ± 890 vs. 8,331 ± 563 mg/dl ± min) did not differ. Similarly, plasma insulin levels did not differ between protocols for either group of subjects. Exercise has been proposed as a treatment to reduce glycemia in gestational diabetes. Results from this study indicate a single bout of exercise did not blunt the glycemic response observed following a mixed nutrient meal.     

Management of fetal death after 20 weeks of gestation complicated by placenta previa

Objective.?To determine the frequency and risk factors associated with neonatal chemical hypoglycemia in neonates of mothers with type 2 diabetes and gestational diabetes mellitus (GDM).

Research Design and Methods.?A retrospective cohort study of women with type 2 diabetes or GDM and their singleton neonates. The primary outcome measure was the presence of neonatal chemical hypoglycemia (capillary plasma equivalent glucose <45?mg/dl) within 1?h of birth. Statistical methods included bivariate and multivariate analyses.

Results.?242 mother infant dyads were identified. Sixty-eight (28%) were treated with diet, 110 (46%) with glyburide, and 64 (26%) with insulin. The incidence of neonatal chemical hypoglycemia was 18% (44/242). The incidence was significantly higher in those requiring pharmacotherapy (25% vs. 3%, p?p?=?0.58). The frequency of neonatal chemical hypoglycemia was statistically associated with birth weight, macrosomia and ponderal index (p?Conclusion.?Neonatal chemical hypoglycemia occurs more frequently in infants from women with type 2 diabetes and GDM treated with glyburide or insulin. An increased neonatal ponderal index is a strong predictor of significant neonatal chemical hypoglycemia.     

Use of insulin glargine during pregnancy: a case-control pilot study

OBJECTIVE: To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN: A matched case-control study. SETTING: Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE: Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS: Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES: Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS: There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS: The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.     

Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose

Objectives.?Maternal overweight is a risk factor for gestational diabetes (GDM) and for newborn macrosomia. Among women without GDM, it is not well understood why some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. We wanted to explore the effect of BMI and fasting plasma glucose (FPG), fasting plasma insulin (FPI) and insulin resistance (HOMA-IR) on the risk of newborn macrosomia.

Methods.?A cohort of 553 Caucasian women was followed throughout pregnancy. The dependent variable was high birth weight (≥4200?g). Independent variables included gestational age, intake of macronutrients and energy, maternal BMI, weight gain, FPG, FPI and HOMA-IR.

Results.?FPG in late pregnancy (30–32 weeks) remained a significant determinant of newborn macrosomia in multiple regression analysis (OR: 1.9, 95% CI: [1.1, 3.4]), whereas FPI and HOMA-IR did not. The women in the highest BMI quartile (≥27?kg/m²) who gave birth to macrosomic newborns had higher increase in FPG and HOMA-IR from early to late pregnancy. Among women in this BMI category, the risk for delivering a macrosomic infant was higher among those with an increase in FPG above 0.60?mmol/l (upper quartile) (OR?=?4.5, 95% CI: [1.7, 12.5]).

Conclusion.?Fasting plasma glucose at week 30–32, but not fasting plasma insulin or insulin resistance, is a determinant of newborn macrosomia. Overweight women with high increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with high BMI.     

Significance of RBP4 in patients with gestational diabetes mellitus: a case-control study of Han Chinese women

The role of retinol binding protein 4 (RBP4) in insulin resistance was recently identified. Our study investigated the correlation between RBP4 levels with lipid and glucose metabolism in a case-control study of women with gestational diabetes mellitus (GDM). Between May 2008 and May 2010, 70 pregnant women (24–28 weeks gestation) were recruited, including 35 women with GDM and 35 healthy controls. Blood samples were collected prior to and after oral glucose tolerance tests (OGTT) to detect serum RBP4, insulin, glycated hemoglobin, triglyceride (TG) and total cholesterol (TC) levels; the insulin resistance index (HOMA-IR) was calculated. Serum RBP4 levels in the GDM group were significantly higher than the control group (22.9?±?3.09?µg/ml versus 17.9?±?3.91?µg/ml; p?p?r?=?0.49, 0.49, 0.52,0.52, respectively; p?相似文献   

Insulin resistance and β-cell function influence postprandial blood glucose levels in Japanese patients with gestational diabetes mellitus

Abstract

Aims/introduction: The aim of this study in patients with gestational diabetes mellitus (GDM) was to evaluate the relationship of insulin resistance and secretion to area-under-the-sensor glucose concentration–time curve from before to 120?min postmeal (CGM-AUC_0–120?min) as determined with continuous glucose monitoring (CGM).

Materials and methods: Immunoreactive insulin and HbA1c were determined in 22 Japanese patients with GDM undergoing a 75?g oral glucose tolerance test. Patients underwent CGM within 3 weeks of receiving a diagnosis of GDM.

Results: HbA1c (NGSP) was 5.5?±?0.4%, BMI was 24.8?±?5.3?kg/m², mean sensor glucose by CGM was 94.2?±?10.3?mg/dL, standard deviation was 17.5?±?4.4?mg/dL, and CGM-AUC_0–120?min was 204.2?±?23.8?h?mg/dL. The insulin resistance indices the homeostasis model assessment ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), and the Matsuda Index were correlated with CGM-AUC_0–120?min. The disposition index (DI), which was used to evaluate insulin secretion, was negatively correlated with CGM-AUC_0–120?min.

Conclusions: Not only insulin resistance but also beta cell dysfunction contributes to postprandial hyperglycemia in Japanese patients with GDM.     

Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

OBJECTIVE: This study was undertaken to compare the use of glyburide with insulin for the treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. STUDY DESIGN: A retrospective study was performed among women with singleton pregnancies who had GDM diagnosed, with fasting plasma glucose 140 mg/dL or less on glucose tolerance testing, between 12 and 34 weeks who failed diet therapy from 1999 to 2002. We identified 584 women and compared those treated with insulin between 1999 and 2000 with women treated with glyburide between 2001 and 2002. Maternal and neonatal outcomes and complications were assessed. Statistical methods included univariate analyses and multivariable logistic regression. RESULTS: In 1999 through 2000, 268 women had GDM diagnosed and were treated with insulin; in 2001 through 2002, 316 women had GDM diagnosed of which 236 (75%) received glyburide. The 2 groups were similar with regard to age, nulliparity, and historical GDM risk factors; however, women in the insulin group had a higher mean body mass index (31.9 vs 30.6 kg/m 2 , P=.04), a greater proportion identified themselves as white (43%, 28%, P<.001) and fewer as Asian (24%, 37%, P=.001), and they had a significantly higher mean fasting on glucose tolerance test (105.4 vs 102.4 mg/dL , P=.005) compared with the glyburide group. There were no significant differences in birth weight (3599+/-650 g vs 3661+/-629 g, P=.3), macrosomia (24%, 25%, P=.7), or cesarean delivery (35%, 39 %, P=.4). Women in the glyburide group had a higher incidence of preeclampsia (12%, 6%, P=.02), and neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P<.05), and less likely to be admitted to the neonatal intensive care unit (NICU) (15%, 24%, P=.008) though they had a longer NICU length of stay (4.3+/-9.6 vs 8.0+/-10.1, P=.002). Posttreatment glycemic control data were available for 122 women treated with insulin and 137 women treated with glyburide. More women in the glyburide group achieved mean fasting and postprandial goals (86%, 63%, P<.001). These findings remained significant in logistic regression analysis. CONCLUSION: In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.     

Predictors for antenatal insulin requirement in gestational diabetes

The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p?相似文献   

Isolated polyhydramnios in the third trimester: is a gestational diabetes evaluation of value?*

We evaluated implications of testing for gestational diabetes mellitus (GDM) in pregnancies complicated by third trimester isolated polyhydramnios with previous negative diabetes screening test. In this retrospective cohort study of 104 pregnant women with polyhydramnios between 2005 and 2013, all had normal first trimester fasting glucose and normal glucose challenge test (GCT?p?=?0.38) or fasting glucose values (82 vs. 86?mg/dL, p?=?0.29) between women in the polyhydramnios group with and without late GDM diagnosis. Moreover, no significant difference was found in relation to the mode of delivery or birth weight between the studied groups (3437?±?611 vs. 3331?±?515?g, p?=?0.63). Diagnosis of third trimester polyhydramnios was not associated with increased risk for GDM or neonatal complications.     

Plasma visfatin levels in pregnant women with normal glucose tolerance,gestational diabetes and pre-gestational diabetes mellitus

Objective.?Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1?h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance.

Methods.?The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled.

Results.?Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P?<?0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P?>?0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1?h after the glucose tolerance test in both Groups 1 and 3 (P?>?0.05).

Conclusions.?Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.     

Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial

Abstract

Objective: To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk of this disorder.

Design: A prospective, randomized, double-blind, placebo controlled clinical trial, pilot study.

Participants: Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.

Intervention: Supplementation with myo-inositol or placebo during pregnancy.

Main outcome measure: Development of GDM on a 75?g oral glucose tolerance test at 24–28 weeks’ gestation. Secondary outcome measures were increased in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.

Results: Thirty-six women were allocated to receive myo-inositol and 39 placebo. The incidence of GDM in mid-pregnancy was significantly reduced (p?=?0.001) in women randomized to receive myo-inositol compared to placebo (relative risk 0.127). Women randomized to receive myo-inositol also required less insulin therapy, delivered at a later gestational age, had significantly smaller babies with fewer episodes of neonatal hypoglycemia.

Conclusions: Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder. The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes.     

Insulin detemir versus glyburide in women with gestational diabetes mellitus

Aim: To evaluate the safety, efficacy and pregnancy outcomes of insulin detemir (IDet) versus glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods: We conducted a retrospective cohort study of women with GDM who were treated with either glyburide or IDet for GDM in a university-affiliated tertiary hospital.

Results: Ninety-one patients with GDM were enrolled, 62 were administered glyburide and 29 IDet. Maternal age, pregestational body mass index (BMI) and rate of abnormal oral glucose tolerance test (OGTT) blood glucose values were not significantly different between groups. Good glycemic control rates were comparable. Hypoglycemic episodes were reported only in the glyburide group (19.4% versus 0%, p?=?0.01). Maternal weight gain during pregnancy was significantly higher among women in the glyburide group (8.8?±?5.1?kg, p?p?=?0.71).

Conclusions: To the best of our knowledge, this is the first study on IDet treatment in patients with GDM. By our preliminary results, IDet is a viable treatment option in women with GDM. Further large prospective studies are needed to determine the efficacy and safety of IDet in GDM patients.     

Differential insulin response to myo-inositol administration in obese polycystic ovary syndrome patients

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulation, polycystic ovaries at ultrasound evaluation, and quite frequently by insulin resistance or compensatory hyperinsulinemia. Attention has been given to the role of inositol-phosphoglycan (IPG) mediators of insulin action and growing evidences suggest that a deficiency of d-chiro-inositol (DCI) containing IPG might be at the basis of insulin resistance, frequent in PCOS patients. On such basis, we investigated the efficacy on insulin sensitivity and hormonal parameters of 8 weeks treatment with myo-inositol (MYO) (Inofert, ItalPharmaco, Milano, Italy) at the dosage of 2 g day in a group (n = 42) of obese PCOS patients,. After the treatment interval body mass index (BMI) and insulin resistance decreased together with luteinizing hormone (LH), LH/FSH and insulin. When subdividing the patients according to their fasting insulin levels, Group A (n = 15) insulin below 12 µU/ml and Group B (n = 27) insulin above 12 µU/ml, MYO treatment induced similar changes in both groups but only patients of Group B showed the significant decrease of both fasting insulin plasma levels (from 20.3 ± 1.8 to 12.9 ± 1.8 µU/ml, p < 0.00001) and of area under the curve (AUC) of insulin under oral glucose tolerance test (OGTT). In conclusion, our study supports the hypothesis that MYO administration is more effective in obese patients with high fasting insulin plasma levels.     

Metformin in normal-weight hirsute women with polycystic ovary syndrome with normal insulin sensitivity

Fifteen normal-weight (body mass index (BMI) 21.50 ± 1.65 kg/m²) hirsute women with polycystic ovary syndrome and normal insulin sensitivity were treated with 850 mg metformin orally, three times daily, for 4 months. Before and at the end of the treatment, clinical data as well as serum concentrations of sex steroid hormones, gonadotropins, fasting plasma glucose and insulin, insulin resistance – homeostasis model assessment (HOMA-IR), carbohydrate tolerance and the area under the curve for insulin (AUC_insulin) were analyzed. Three patients withdrew from the study. Seven of the remaining 12 patients presented menstrual pattern improvement, followed by ovulatory cycles at the end of the treatment period. There were no changes in BMI and hirsutism score. A significant (p < 0.05) decrease in luteinizing hormone (LH) (from 8.18 ± 4.34 to 5.05 ± 1.53 IU/ml), testosterone (from 104.66 ± 27.54 to 82.00 ± 23.05 ng/dl), fasting insulin (from 9.66 ± 4.79 to 7.83 ± 3.06 µIU/ml), AUC_insulin (from 9239 ± 3285 to 7660 ± 2565 µUI/ml × min) and HOMA-IR (from 2.15 ± 1.2 to 1.67 ± 0.74), and a significant increase in follicle-stimulating hormone (FSH) (from 4.05 ± 1.53 to 5.96 ± 2.13 IU/ml), were observed at the end of the treatment period. A higher LH and a lower FSH predicted clinical improvement, while basal insulin and AUC_insulin showed lower predictive value.