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This version published online on December 14, 2004
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-1965
A more recent version of this article appeared on March 1, 2005
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Submitted on October 7, 2004
Accepted on December 6, 2004

Responses of Serum Androgen and Insulin Resistance to Metformin and Pioglitazone in Obese, Insulin-resistant Women with Polycystic Ovary Syndrome

C. Ortega-González M.D.*, S. Luna M.D., L Hernández M.D., G. Crespo M.D., P. Aguayo M.D., G. Arteaga-Troncoso MVZ, and A. Parra M.D.

From Department of Endocrinology, Department of Sterility and Direction of Investigation, Instituto Nacional de Perinatología, México City, México

* To whom correspondence should be addressed. E-mail: ortegacarlos{at}.hotmail.com.

Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate whether pioglitazone decreases insulin resistance and hyperandrogenism to the same extent as metformin in obese women with PCOS naïve to any previous treatment. Fifty-two women with PCOS were randomly allocated to receive either pioglitazone (30 mg a day, n = 25) or metformin (850 mg three times daily, n = 27) and were assessed before and after six months. Body weight, body mass index, and waist-to-hip ratio increased significantly (P ≤ 0.05) after pioglitazone but not after metformin treatment. Fasting serum insulin concentration (P < 0.001 for both drugs) and the area under the insulin curve during a 2 h oral glucose tolerance test decreased after pioglitazone (P < 0.002) or metformin (P < 0.05) treatment. Insulin resistance (HOMA-IR index) decreased and insulin sensitivity (elevation of the QUICKI index and the fasting glucose/insulin ratio) increased (P ≤ 0.008) after treatment with either drug. Hirsutism (P < 0.05) and serum concentrations of free testosterone (P < 0.02) and androstenedione (P < 0.01) declined to a similar extent after treatment with the drugs. Treatment with pioglitazone or metformin was associated with the occurrence of pregnancy (n = 5 and n = 3, respectively). These results suggest that pioglitazone is as effective as metformin in improving insulin sensitivity and hyperandrogenism, despite an increase in body weight, body mass index, and the waist-to-hip ratio associated with pioglitazone.
Key words: Insulin resistance • Hyperandrogenism • Insulin sensitivity • Metformin • Obese PCOS • Pioglitazone




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