Abstract
BackgroundImpaired insulin activity in women with polycystic ovary syndrome might differ from that seen in type 2 diabetes mellitus without polycystic ovary syndrome. This study was designed to compare the effects of treatment with metformin, saxagliptin, and their combination in newly diagnosed women with type 2 diabetes mellitus and polycystic ovary syndrome in China.MethodsA total of 75 newly diagnosed patients from Shanghai, China with type 2 diabetes mellitus and polycystic ovary syndrome were included in this randomized, parallel, open-label study. All patients received treatment for 24 weeks with metformin, saxagliptin, or their combination. Patients were allocated to one of three treatment groups by a computer-generated code that facilitated equal patient distribution of 25 patients per group. The primary outcome was a change in glycemic control and β-cell function.ResultsA total of 63 patients completed the study (n = 21, for each group). The reduction in hemoglobin A1c was significant in the combination group, compared to the monotherapy groups (saxagliptin vs. combination treatment vs. metformin: − 1.1 vs. -1.3 vs. -1.1%, P = 0.016), whereas it was comparable between the metformin and saxagliptin groups (P > 0.05). Saxagliptin, metformin, and the combination treatment significantly reduced the homeostasis model assessment- insulin resistance index and increased the deposition index (P < 0.01 for all). However, no significant change was observed in the homeostasis model assessment- β-cell function among the metformin and combination groups, and no significant changes were observed in the insulinogenic index among all three groups (P > 0.05 for all). In addition, saxagliptin and metformin treatments significantly reduced body mass index and high-sensitivity C-reactive protein levels (P < 0.01 for both).ConclusionsSaxagliptin and metformin were comparably effective in regulating weight loss, glycemic control, and β-cell function, improving lipid profiles, and reducing inflammation in newly diagnosed type 2 diabetes mellitus patients with polycystic ovary syndrome.Trial registrationChiCTR-IPR-17011120 (retrospectively registered on 2017–04-12).
Highlights
Impaired insulin activity in women with polycystic ovary syndrome might differ from that seen in type 2 diabetes mellitus without polycystic ovary syndrome
The findings of Dunaif and coworkers [4] suggested that the impaired insulin activity in women with Polycystic ovary syndrome (PCOS) might differ from that seen in type 2 diabetes mellitus (T2DM) without PCOS, or in obese women, who did not exhibit the classical features of PCOS
The fasting blood glucose (FBG), 2-h glucose (2hBG), fasting insulin (FINS), 2-h insulin (2hINS), hemoglobin A1c (HbA1c), AUC glucose, and AUC insulin values showed no significant differences among the various groups (P > 0.05 for all)
Summary
Impaired insulin activity in women with polycystic ovary syndrome might differ from that seen in type 2 diabetes mellitus without polycystic ovary syndrome. This study was designed to compare the effects of treatment with metformin, saxagliptin, and their combination in newly diagnosed women with type 2 diabetes mellitus and polycystic ovary syndrome in China. Polycystic ovary syndrome (PCOS) affects 6–10% of reproductive-age women. About 30–40% of obese reproductive-age women with PCOS have impaired glucose tolerance (IGT) [1, 2], and approximately 10% have type 2 diabetes mellitus (T2DM) based on a 2-h glucose level > 200 mg/dL [3]. Our previous study [5] reported early impairment of β-cell function in women with PCOS. An important consideration is raised about the manner in which interventions might effectively treat hyperglycemia in women with T2DM and PCOS
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