Pioglitazone treatment demonstrated improvements in insulin sensitivity

In overweight and obese women with polycystic ovary syndrome, pioglitazone use improved insulin action, glucose homeostasis and hyperandrogenic ovarian response.

Researchers randomly assigned 23 women with PCOS to placebo or 45 mg of pioglitazone (Actos, Takeda) daily for six months. Six women without PCOS were evaluated at baseline for comparison.

Glucose disposal rate was 7.26 mg/kg per minute for the pioglitazone group and 6.89 mg/kg per minute for the placebo group. The two-hour glucose during a 75-g oral glucose tolerance test was 134.5 mg/dL in the pioglitazone group compared with the placebo group (151.8 mg/dL). In the pioglitazone group, the area under the curve for glucose during the OGTT was 17,863 vs. the placebo group (18,486).

Serum adiponectin (20.08 mcg/mL) and fasting insulin (21.30 mcIU/mL) measures were improved in the pioglitazone group compared with the measures for adiponectin (11.33 mcg/mL) and fasting insulin (26.64 mcIU/mL) in the placebo group. The researchers reported a decrease in the increment of leuprolide-stimulated 17-hydroxyprogesterone with pioglitazone treatment (P<.02). Decreases in 17- hydroxyprogesterone stimulation were linked to improvements in glucose disposal rates (P<.02), according to the study. – by Christen Haigh

J Clin Endocrinol Metab. 2009;94:469-476.

This report elegantly corroborates earlier study results that demonstrated a stimulatory effect of insulin resistance/hyperinsulinemia on ovarian androgen production in women with PCOS. From a clinical viewpoint, pioglitazone may be particularly useful in forestalling or preventing the development of glucose intolerance in PCOS. However, its utility is presently limited by the attendant edema, weight gain, teratogenicity (a pregnancy Category C drug), risk for congestive heart failure in susceptible individuals and recent concerns about adverse effects on bone health in women.

– John E. Nestler, MD

Endocrine Today Editorial Board member