Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study

Penna, Ivan Araújo; Canella, Paulo Roberto Bastos; Reis, Rosana Maria dos; Sá, Marcos Felipe Silva de; Ferriani, Rui Alberto

doi:10.1093/humrep/dei104

Cited by 67 publications

(37 citation statements)

References 41 publications

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“…3,4 Furthermore, insulin resistance and/ or compensatory hyperinsulinemia appear to play a key role in the pathophysiology of this disorder. 3,[5][6][7][8] Reduction of insulin or insulin resistance with acarbose, diazoxide, weight loss, or insulin-sensitizing drugs improves ovulatory frequency, [9][10][11] corrects oligomenorrhea, and reduces hyperandrogenism [11][12][13][14][15][16][17] and hirsutism 18 in PCOS. However, the subcellular mechanisms underlying the insulin resistance in this disorder are unclear.…”

Section: Introductionmentioning

confidence: 99%

Uncoupling Between Insulin and Release of ad-Chiro-Inositol–Containing Inositolphosphoglycan Mediator of Insulin Action in Obese Women With Polycystic Ovary Syndrome

Baillargeon

Iuorno

Apridonidze

et al. 2010

Metabolic Syndrome and Related Disorders

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Background: Obese women with polycystic ovary syndrome (PCOS) manifest impaired insulin-stimulated release of a d-chiro-inositol-containing inositolphosphoglycan (DCI-IPG) insulin mediator during oral glucose tolerance testing (OGTT), which appears to be restored by the administration of metformin. This suggests that either obesity or PCOS is associated with a defect in the coupling of the stimulation of the insulin receptor by insulin to the release of the DCI-IPG mediator. The objective of this study was to compare the release of bioactive DCI-IPG between normal nonobese women and obese PCOS women during stimulation with two different concentrations of insulin when glucose levels are clamped. Methods: We performed a cross-sectional case-control study at the clinical research center of an academic medical center. A two-step euglycemic-hyperinsulinemic clamp was carried out in 8 nonobese normal and 8 obese PCOS women, during which DCI-IPG bioactivity was monitored. Results: At baseline, PCOS women were signifi cantly more obese, hyperinsulinemic, and insulin resistant than the controls. During the clamp studies, DCI-IPG bioactivity increased signifi cantly over the fi rst 45 min of the low-insulin step of the clamp in normal nonobese women (P = 0.046) and then decreased to baseline levels; DCI-IPG increased again after initiation of the high-insulin step (P = 0.029). Despite higher insulin levels during the clamp in PCOS women, DCI-IPG bioactivity remained fl at throughout both insulin steps and was thus significantly lower than in controls during the initial periods of both steps. Conclusions:The coupling between insulin action and the release of the DCI-IPG mediator is selectively impaired in obese PCOS women, which may contribute to the insulin resistance in these women.

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Section: Introductionmentioning

confidence: 99%

Uncoupling Between Insulin and Release of ad-Chiro-Inositol–Containing Inositolphosphoglycan Mediator of Insulin Action in Obese Women With Polycystic Ovary Syndrome

Baillargeon

Iuorno

Apridonidze

et al. 2010

Metabolic Syndrome and Related Disorders

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“…In clinical trials on treatment of hyperglycemia it was noticed that acarbose has a favorable effect on body weight (Purnell and Weyer, 2003). Acarbose has been successfully tested for controlling body weight in hyperinsulinaemic women with polycystic ovarian syndrome, which showed a significant reduction of BMI after six months of treatment (Penna et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Daily consumption of Reliv Glucaffect™ for 8 weeks significantly lowered blood glucose and body weight in 50 subjects

Belcaro

Cesarone

Errichi

et al. 2009

Phytotherapy Research

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A public change to healthier lifestyles with more physical activity and better nutrition, including caloric restriction, is required to address the obesity epidemic. Weight loss can be achieved by caloric restrictions; current research suggests that this may be achieved by consumption of slowly absorbed carbohydrates owing to the resulting prolonged satiety. Our rationale was to prolong the satiety of overweight volunteers by supplementation with a proprietary formulation Glucaffect which delays absorption of carbohydrates. Glucaffect provides potent alpha-glucosidase inhibitors of herbal source such Pycnogenol, Madeglucyl and various others which obstruct absorption of carbohydrates, such as starch. Fifty overweight subjects received either Glucaffect or an inactive control product for eight weeks. Consumption of Glucaffect was found to statistically significantly lower blood-fasting glucose from baseline 145.3 mg/dL to 101.1 mg/dL (-30.4%) and Hba1c from 7.59% to 6.33% as compared to the control group where values decreased only marginally. The weight and the body mass index (BMI) decreased significantly from an average of 88.5 kg (BMI 26.8 kg/m2) to 81.3 kg (BMI 24.5 kg/m2) as compared to the control group. In conclusion, Glucaffect enabled subjects with metabolic syndrome to achieve healthy BMI and blood glucose levels. Glucaffect was well tolerated and no subject dropped out.

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“…[72][73][74][75] The potential role of acarbose in PCOS has been studied, but its effects on insulin sensitivity parameters, body mass, and vascular function were inconsistent and there was no significant improvement of PCOS-related dyslipidemia. 74,75 Adverse effects, predominantly gastrointestinal, are common, and potentially fatal hepatotoxicity has been reported. Inconsistent efficacy, bothersome side effects, and the risk of liver damage limit the role of this agent in clinical practice.…”

Section: Acarbosementioning

confidence: 99%

Advances in Treatment Options for Polycystic Ovary Syndrome

Lathief¹,

Pal²

2012

US Endocrinology

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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy seen in women of reproductive age. Clinical concerns relating to PCOS range from ovulatory infertility and menstrual disorders to risk of diabetes and cardiovascular disease. Hormonal contraceptives have been the mainstay of the management of common PCOS symptoms, such as menstrual irregularity and clinical stigmata of androgen excess (i.e., hirsutism and acne). An appreciation of the relevance of metabolic pathways in the pathophysiology of PCOS is relatively recent, and has translated into an expansion of the therapeutic strategies available for the management of PCOS.Insulin sensitizers were one of the first metabolic modulators to be incorporated in the clinical management paradigm, albeit with mixed results. Recognizing that insulin resistance is central to the pathophysiology of PCOS, newer agents-e.g., thiazolidinedionesfollowed, with almost comparable efficacy to metformin. Statins and most recently incretins constitute novel therapies with distinct metabolic targets that seem to hold promise in the management of PCOS. In tandem with the expansion in pharmaceuticals, a host of complementary and alternative medical therapies have generated interest for purported promise in the management of PCOS, including vitamin D, acarbose, and myo-inositol. The therapeutic options for managing PCOS-related infertility have also expanded. Clomiphene citrate (CC) has long been the first-line strategy for ovulation induction in the setting of anovulatory infertility; however, aromatase inhibitors are fast gaining acceptance as an ovulation induction strategy, with results comparable or even better than those seen with CC. An increasing level of therapeutic sophistication is reflected in ovarian stimulation protocols judiciously using gonadotropins, gonadotropin-releasing hormone antagonists, the procedure of ovarian drilling, and assisted reproductive technologies with in vitro oocyte maturation. KeywordsPolycystic ovary syndrome, androgen, oral contraceptive, antiandrogen, spironolactone, finasteride, flutamide, eflornithine, insulin, metformin, thiazolidinediones, incretins, statins, acarbose, myo-inositol In this article, the authors have attempted to provide an overview of the treatment options that offer therapeutic benefit in PCOS. Treatment Options for Targeting Common Symptoms Combined Oral ContraceptivesHaving long been used as the first-line treatment in PCOS management, combined oral contraceptives (COCs) offer not just menstrual regulation and endometrial protection, but also a benefit against cutaneous stigmata of hyperandrogenism in women with PCOS. 5-7Mechanisms whereby COCs mediate improvements in PCOS-related symptoms include:• a suppression of pituitary luteinizing hormone (LH), thereby reducing the stimulant effect of LH on androgen production by the ovarian theca cells;• an increase in hepatic sex hormone binding globulin (SHBG) directly resulting from the estrogen component in the COC; the net effect is a

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Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study

Abstract: A low dose of acarbose administered to obese patients with PCOS promotes a reduction in free androgen index and BMI and an increase in SHBG, with improvement of hirsutism and of the menstrual pattern, and is well tolerated by patients.

Cited by 67 publications

References 41 publications

Uncoupling Between Insulin and Release of ad-Chiro-Inositol–Containing Inositolphosphoglycan Mediator of Insulin Action in Obese Women With Polycystic Ovary Syndrome

Uncoupling Between Insulin and Release of ad-Chiro-Inositol–Containing Inositolphosphoglycan Mediator of Insulin Action in Obese Women With Polycystic Ovary Syndrome

Daily consumption of Reliv Glucaffect™ for 8 weeks significantly lowered blood glucose and body weight in 50 subjects

Advances in Treatment Options for Polycystic Ovary Syndrome

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