Predictive value of glucose-insulin ratio in PCOS and profile of women who will benefit from metformin therapy: obese, lean, hyper or normoinsulinemic?
OBJECTIVE
The aim of the present study is to evaluate sub-groups of PCOS patients who will benefit from metformin therapy and to find out any predictors of ovulation in PCOS sub-groups.


METHODS
In the current prospective-randomized, placebo-controlled, double-blind study, PCOS patients (n = 116) were divided into six main groups according to glucose to insulin ratio (G-I ratio mg/10(-4) U) and body mass index (BMI kg/m2) as: Group 1: normoinsulinemic (G-I ratio > or = 4.5 mg/10(-4) U), lean (BMI < 25) (n = 37); Group 2: normoinsulinemic, overweight (BMI: 25-29.9) (n = 19); Group 3: normoinsulinemic, obese (BMI > or = 30) (n = 18); Group 4: hyperinsulinemic (G-I ratio < 4.5 mg/10(-4) U), lean (n = 28); Group 5: hyperinsulinemic, overweight (n = 17); Group 6: hyperinsulinemic, obese (n = 20). Patients in each group were randomized onto placebo or metformin treatments (850 mg two to three times per day according to BMI). The rate of ovulation, biochemical profile, hormonal profile and clinical symptoms of hyperandrogenism were evaluated before and after 6 months of metformin and placebo treatments.


RESULTS
We observed a significant decrease in WHR following metformin therapy in the normoinsulinemic overweight sub-group (P < 0.05). The duration of the menstrual cycle significantly decreased in the normoinsulinemic obese sub-group on metformin therapy (P < 0.05). Metformin had a significant effect on hirsutism scores in hyperinsulinemic lean women (P < 0.05) and decreased DHEAS levels significantly in the lean hyperinsulinemic and normoinsulinemic groups (P < 0.05). Metformin had significant effects on ovulation in only lean hyperinsulinemic women (P < 0.05).


CONCLUSIONS
Clinical outcomes of metformin therapy may be categorized on the basis of basal BMI and insulin levels in PCOS patients.
Onalan
Gogsen
G
Centrum Clinic, IVF Division, Nenehatun, No: 59 GOP, Ankara 06700, Turkey. gogsenonalan@yahoo.com
Goktolga
Umit
U
Ceyhan
Temel
T
Bagis
Tayfun
T
Onalan
Reside
R
Pabuçcu
Recai
R
D050154:Adiposity; D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood*; D008687:Metformin / Q000627:therapeutic use*; D009765:Obesity / Q000209:etiology; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin