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Should PCOS be treated with insulin sensitizers or oral contraceptives?(POINT/COUNTERPOINT)
Insulin Sensitizers
Polycystic ovary syndrome (PCOS) is characterized by androgen excess and oligoovulation. It is the most common cause of infertility in the United States and affects more than 5 million women.
Oral contraceptives (OCs) are the traditional chronic treatment of choice for these women, but I think there are many good reasons to prefer metformin or other insulin-sensitizing drugs not only for the acute treatment of infertility (I think all can agree that this is an excellent use of insulin sensitizers), but also for chronic use.
Most if not all women with PCOS have insulin resistance; indeed, insulin resistance is intrinsic to the syndrome. Studies comparing lean and obese women, with PCOS and without, have shown that lean women with PCOS are as insulin resistant as obese normal women. And obese women with PCOS are the most insulin resistant of them all.
As is well known, women with insulin resistance are at high risk of developing type 2 diabetes and cardiovascular disease. In fact, in a recent study, Dr. Legro showed that there was an annual 16% conversion from normal glucose tolerance to impaired glucose tolerance in women with PCOS. All in all, 30%-50% of obese women with PCOS will develop either impaired glucose tolerance or type 2 diabetes by the age of 30 years, making women with PCOS one of the groups at highest risk for type 2 diabetes.
Women with PCOS also express many recognized cardiovascular risk factors in excess. They tend to be hypertensive; they have vascular dysfunctions; and they have low HDL, high triglycerides, high plasminogen activator inhibitor-1 (PAI-1), high endothelin-1, and high C-reactive protein.
In fact, one recent study indicates that more than 90% of women with PCOS have at least one cardiovascular risk factor, and about 70% have two or more. In the Nurses' Health Study, which followed more than 80,000 women for 14 years, women with very irregular menses (most of whom likely had PCOS) had a twofold increased incidence of myocardial infarction.
- Should PCOS be treated with insulin sensitizers or oral...
- Magazine article from: Family Practice News Nestler, John Legro, Richard S. February 1, 2006 700+ words
Insulin Sensitizers Polycystic...syndrome (PCOS) is characterized...likely had PCOS) had a twofold...infarction. Insulin sensitizers not only...benefits in PCOS, tipping...favor of insulin sensitizers. Future...
- Use of insulin sensitizers for type 2 diabetes reviewed.
- Newspaper article from: Drug Week May 30, 2003 700+ words
...NewsRx.net) -- The use of insulin sensitizers for the treatment of type 2 diabetes...United States. "Evidence shows that insulin sensitizers not only have beneficial effects...in the Mayo Clinic Proceedings (Insulin sensitizers. Mayo Clin Proc, 2003;78(4...
- Prandin(R) (Repaglinide) Approved for New Indication: Combination Therapy With...
- Press release article from: PR Newswire October 22, 2002 700+ words
...of another class of OADs called insulin sensitizers, for the treatment of type 2 diabetes...highly effective agent to use with insulin sensitizers because of its ability to augment...stimulates insulin secretion, whereas insulin sensitizers primarily improve the body's response...
- Insulin Sensitizers Under Development.
- Press release article from: M2 Presswire January 14, 2003 700+ words
M2 PRESSWIRE-14 January 2003-Research and Markets: Insulin Sensitizers Under Development(C)1994-2003 M2 COMMUNICATIONS LTD RDATE:01122003 Database Table: Insulin Sensitizers Under Development Database Tables are proprietary data sources...
- Insulin sensitizers cut cognitive decline in AD.(care and treatment)(clinical...
- Magazine article from: Clinical Psychiatry News Finn, Robert April 1, 2006 700+ words
...FRANCISCO -- A growing body of evidence suggests that insulin sensitizers may avert cognitive decline in people with Alzheimer...confirmed in larger studies, they open the possibility that insulin sensitizers may provide an effective treatment for the cognitive decline...
- Advances in insulin sensitizers reviewed.
- Newspaper article from: Obesity, Fitness & Wellness Week October 23, 2004 700+ words
...amp; NewsRx.net) -- Researchers review advances in insulin sensitizers in a recent issue of Current Medicinal Chemistry. According...their study in Current Medicinal Chemistry (Advances in insulin sensitizers. Curr Medicinal Chem, 2004;11(18):2467-2503...
- STUDIES SHOW COMBINATION THERAPY OF ORAL ANTIDIABETIC DRUG REPAGLINIDE AND...
- Press release article from: PR Newswire June 23, 2001 700+ words
...control can be improved with repaglinide in combination with insulin sensitizers," said Philip Raskin, M.D., an author of both studies...Repaglinide stimulates insulin release from the pancreas; insulin sensitizers, such as pioglitazone, rosiglitazone and metformin...
- Insulin sensitizers cut cognitive decline in AD.(Alzheimer's disease)
- Magazine article from: Internal Medicine News Finn, Robert January 15, 2006 700+ words
SAN FRANCISCO -- A growing body of evidence suggests that insulin sensitizers may avert cognitive decline in people with Alzheimer's disease, Suzanne Craft, Ph.D., said at the Third World Congress...
