Acarbose is as effective as metformin in reducing central obesity in infertile women with polycystic ovary syndrome

Tahmida Islam; Asma Akter; Rawnok Laila; Rafikunnahar Renu; Sumyara Khatun; Shakeela Ishrat

doi:10.18203/2320-1770.ijrcog20242805

Authors

Tahmida Islam Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Asma Akter Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Rawnok Laila Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Rafikunnahar Renu Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Sumyara Khatun Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Shakeela Ishrat Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh https://orcid.org/0000-0002-8568-0417

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242805

Keywords:

PCOS, Acarbose, Metformin, Overweight, Insulin resistance

Abstract

Background: Polycystic ovary syndrome (PCOS) in infertile women is frequently associated with insulin resistance and obesity. Optimization of the patient by reducing weight and insulin resistance improves clinical, biochemical & endocrine parameters and consequently increases the chance of successful ovulation and pregnancy. Acarbose is an alpha-glucosidase inhibitor which acts by reducing and slowing down intestinal absorption of glucose, with a reduction of the postprandial glucose wave and a consequent reduction of insulin secretion. The objective of this study was to evaluate the efficacy of acarbose compared to metformin, in reducing central obesity in infertile women with PCOS.

Methods: This randomized controlled trial study was conducted on a total 60 infertile, overweight and obese women with PCOS. The women were allocated randomly to two treatment arms: one group receiving acarbose 100 mg three times daily with meal for 3 months and another group receiving metformin 500 mg three times daily after meal for 3 months. The main outcome variables were changes in central obesity and insulin resistance.

Results: Mean weight, BMI, waist circumference and waist hip ratio was significantly decreased in both acarbose and metformin group. Reduction of fasting blood sugar, fasting insulin and HOMA-IR were also significant. The reduction was more in acarbose group, but the difference was not statistically significant. Gastrointestinal side effects were more in the women given metformin.

Conclusion: There is significant reduction in central obesity or insulin resistance parameters in infertile PCOS women given acarbose or metformin over three months. However, there is no statistically significant difference between the two groups. Acarbose has less gastrointestinal side effects, so can be a suitable alternative to metformin in those who are intolerant to metformin.

Metrics

Metrics Loading ...

References

Hajishafiha M, Dehghan M, Kiarang N, Sadegh-Asadi N, Shayegh SN and Ghasemi-Rad M. Combined letrozole and clomiphene versus letrozole and clomiphene alone in infertile patients with polycystic ovary syndrome. Drug Des Devel Ther. 2013;3:1427-31.

Karabulut A, Yaylali GF, Demirlenk S, Sevket O and Acun A. Evaluation of body fat distribution in PCOS and its association with carotid atherosclerosis and insulin resistance. Gynecol Endocrinol 2012;28(2):111-4.

Jena D, Choudhury AK, Mangaraj S, Singh M, Mohanty BK and Baliarsinha AK. Study of visceral and subcutaneous abdominal fat thickness and its correlation with cardiometabolic risk factors and hormonal parameters in polycystic ovary syndrome. Indian J Endocrinol Metab. 2018;22(3):321-7.

Mu L, Zhao Y, Li R, Lai Y and Qiao J. Metabolic characteristics of normal weight central obesity phenotype polycystic ovary syndrome women: a large-scale national epidemiological survey. Reprod Biomed Online 2018;37(4):498-504.

Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: An update. World J Diabetes. 2022;13(3):129.

Laube H. Acarbose. Clin Drug Investig 2002;22:141-56.

Nakhaee A and Sanjari M. Evaluation of effect of acarbose consumption on weight losing in non-diabetic overweight or obese patients in Kerman. J Res Med. 2013;18(5):391.

Kircher C and Smith K. Acarbose for Polycystic Ovary Syndrome. Ann Pharmacother. 2008;42(6):47–851.

Hanjalic-Beck A, Gabriel B, Schaefer W, Zahradnik HP, Schories M, Tempfer C et al. Metformin versus acarbose therapy in patients with polycystic ovary syndrome (PCOS): a prospective randomised double-blind study. Gynecol Endocrinol. 2010;26(9):690-97.

Ciotta L, Calogero AE, Farina M, De Leo V, La Marca A and Cianci A. Clinical, endocrine and metabolic effects of acarbose, an α-glucosidase inhibitor, in PCOS patients with increased insulin response and normal glucose tolerance. Hum Reprod. 2001;16(10):2066-72.

Rezai M, Jamshidi M, Mohammadbeigi R, Seyedoshohadaei F, Mohammadipour S, Moradi G. Comparing the effect of metformin and acarbose accompanying clomiphene on the successful ovulation induction in infertile women with polycystic ovary syndrome. Glob J Health Sci. 2016;8(9):281.

Sonmez AS, Yaşar L, Savan K, Koç S, Özcan J, Toklar A, et al. Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome. Hum Reprod. 2005; 20(1):175-79.

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18.

Yoon JL, Cho JJ, Park KM, Noh HM, Park YS. Diagnostic performance of body mass index using the Western Pacific Regional Office of World Health Organization reference standards for body fat percentage. Journal of Korean Medical Science. 2015;30(2):162-6.

Banerjee R, Ray K, Bhattacherjee S, Guha S, Banerjee I and Nath I. A Study of Insulin Resistance and its Clinico Metabolic Associations Among Apparently Healthy Individuals Attending a Tertiary Care Hospital. Ann Med Health Sci Res 2014;4(5):823-28.

Guan Y, Wang D, Bu H, Zhao T, Wang H. The effect of metformin on polycystic ovary syndrome in overweight women: a systematic review and meta‐analysis of randomized controlled trials. Int J Endocrinol. 2020;1:5150684.

Kałuzna M, Człapka-Matyasik M, Wachowiak-Ochmańska K, Moczko J, Kaczmarek J, Janicki A, et al. Effect of central obesity and hyperandrogenism on selected inflammatory markers in patients with PCOS: a WHtR-matched case-control study. J Clin Med. 2020;9(9):3024.

Jurczewska J, Ostrowska J, Chełchowska M, Panczyk M, Rudnicka E, Kucharski M, et al. Abdominal Obesity in Women with Polycystic Ovary Syndrome and Its Relationship with Diet, Physical Activity and Insulin Resistance: A Pilot Study. Nutrients. 2023;15(16):3652.

Trikudanathan, S, Raji A, Chamarthi B, Seely EW, Simonson DC. Comparison of insulin sensitivity measures in South Asians. Metabolism. 2013;62(10):1448-54.

Afrin S, Ishrat S, Banu J, Jahan I, Ansary SA and Nasreen K. Acarbose versus Orlistat in weight management of infertile women with polycystic ovarian syndrome: a prospective randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2021;10(4):1272-78.

Penna IAA, Canella PRB, Reis RMD, Silva de Sá MF and Ferriani RA. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study. Hum Reprod 2005;20(9):2396-401.

Khan FA, Mehmood M, Kazmi S, Sheraz S, Bhatti S, Dars JA, et al. Efficacy of Metformin in Obese Versus non-Obese Women with Polycystic Ovary Syndrome (PCOS). Lia Nation J Prim Care. 2022;4(2):124-28.

Jensterle M, Kravos NA, Ferjan S, Goricar K, Dolzan V and Janez A. Long-term efficacy of metformin in overweight-obese PCOS: longitudinal follow-up of retrospective cohort. Endocr Connect. 2020; 9(1):44-54.

Abdalla MA, Shah N, Deshmukh H, Sahebkar A, Östlundh L, Al‐Rifai RH, et al. Impact of pharmacological interventions on insulin resistance in women with polycystic ovary syndrome: A systematic review and meta‐analysis of randomized controlled trials. Clin Endocrinol. 2022; 96(3):371-94.

Wang L, Han T, Yue J, Liu W and Hu Y. A systematic review and meta-analysis of acarbose in the treatment of polycystic ovary Syndrome. J Endocr Disord. 2014;1(3):10-3.