A comparative study of combination of Myo-inositol and D-chiro-inositol versus Metformin in the management of polycystic ovary syndrome in obese women with infertility
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190498Keywords:
D-chiro-inositol, Hirsutism score, Insulin resistance, Myo-inositol, Polycystic ovary syndromeAbstract
Background: Polycystic ovary syndrome (PCOS) is a symptom complex associated with increased amounts of circulating androgens in females, increased insulin resistance and obesity. The drugs, Myo-inositol, D-chiro-inositol and Metformin, which are insulin sensitizers, are very helpful in taking care of one of the key components of PCOS that is insulin resistance. This study was done to compare the effects of combination of Myo-inositol and D-chiro-inositol with the use of metformin on clinical and biochemical profile in PCOS.
Methods: A prospective, randomized, comparative study was conducted on 200 patients. The patients were randomly assigned into the two groups of 100 each. Group A receiving Tab. Myoinositol 550mg twice daily and Tab. D-chiro-inositol 13.8mg twice daily and Group B receiving Tab. Metformin 500mg thrice daily. The patients were assessed by menstrual cycle regulation, hirsutism score (Ferriman Gallwey), fasting and post prandial glucose and insulin levels, serum DHEA levels, serum free testosterone levels and fasting day 3 serum LH and FSH ratio.
Results: In both the groups there was significant improvement in all the above mentioned parameters, however the group with Combination of Myo-inositol and D-chiro-inositol had statistically significant improvement over the Metformin group.
Conclusions: Combination of Myo-inositol and D-chiro-inositol and use of metformin, significantly improved insulin sensitivity in PCOS women. But combination of Myo-inositol and D-chiro-inositol was effective in controlling the hormonal profiles (LH/FSH ration and free testosterone) when compared to Metformin.
References
Tabassum K. Ultrasonographic prevalence of Polycystic Ovarian syndrome in different age groups. Indian J Clin Pract. 2014;25(6).
Tehrani FR, Simbar M, Tohidi M, Hesseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population. Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011;39:1-7.
Malik S, Jain K, Talwar P, Prasad S, Dhorepatil B, Devi G, et al. Management of Polycystic Ovarian Syndrome in India. Fertil Sci Res. 2014;1:23-43.
Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370:685-97.
Rojas J, Chavez M, Olivar L, Rojas M, Morillo J, Mejias J, et al. Polycystic ovary syndrome, insulin resistance and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med. 2014;2014.
Brettenhaler N, De Geyter C, Huber PR, Keller U. Effect of insulin sensitizer pioglitazone on IR, hyperandrogenism and ovulatory dysfunction in women with PCOS. J Clin Endocrinol Metabol. 2004;89(8):3835-40.
Grisouard J, Timper K, Radimerski TM, Frey DM, Peterli R, Kola B, et al. Mechanisms of metformin action on glucose transport and metabolism in human adipocytes. Biochem Pharmacol. 2010;80(11):1736-45.
Croze ML, Soulage CO. Potential role and therapeutic interests of myo-inositol in metabolic diseases. Biochimie. 2013;95(10):1811-27.
Larner J. D-chiro-inositol–its functional role in insulin action and its deficit in insulin resistance. Exp Diabetes Res. 2002;3(1):47-60.
Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008;24(3):139-44.
Huang LC, Fonteles MC, Houston DB, Zhang CH, Larner J. Chiroinositol deficiency and insulin resistance. III. Acute glycogenic and hypoglycemic effects of two inositol phosphoglycan insulin mediators in normal and streptozotocin-diabetic rats in vivo. Endocrinol. 1993;132(2):652-7.
Bevilacqua A, Carlomagno G, Gerli S, Montanino Oliva M, Devroey P, Lanzone A, et al. Results from the International Consensus Conference on myo-inositol and D-chiro-inositol in Obstetrics and Gynecology–assisted reproduction technology. Gynecol Endocrinol. 2015;31(6):441-6.
Facchinetti F, Bizzarri M, Benvenga S, D’Anna R, Lanzone A, Soulage C, et al. Results from the International Consensus Conference on Myo-inositol and d-chiro-inositol in Obstetrics and Gynecology: the link between metabolic syndrome and PCOS. Europ J Obstet Gynecol Reprod Biol. 2015;195:72-6.
Minozzi M, Nordio M, Pajalich R. The combined therapy myo-inositol plus D-chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients. Age (years). 2013;26:5-1.
Nehra J, Kaushal J, Singhal SR, Ghalaut VS. A comparative study of efficacy and safety of myo-inositol versus metformin in polycystic ovarian syndrome in women. World J Pharma Pharmaceut Sci. 2016;5(5):884-96.
Hu L, Shen H, Wu QF, Tian L, Hu MH. Treatment of polycystic ovarian syndrome with insulin sensitizer. Clin Exp Obstet Gynaecol. 2014;41:288-92.
Ortmeyer HK, Bodkin NL, Hansen BC, Larner J. In vivo D-chiroinositol activates skeletal muscle glycogen synthase and inactivates glycogen phosphorylase in rhesus monkeys. J Nutr Biochem. 1995;6(9):499-503.
Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Survey. 2004;59:141-54.
Pintaudi B, Di Vieste G, Bonomo M. The effectiveness of myo-inositol and D-chiro inositol treatment in type 2 diabetes. Int J Endocrinol. 2016;2016.
Awalekar J, Awalekar C, Jadhav VM, Chivate CG, Patwardhan MH. Effect of metformin andmyoinositoland life style modification in patients of polycystic ovarian disease (PCOD). Int J Biomed Res. 2015;6(09):698-704.
