Comparative treatment between sitagliptin vs. metformin, alone or in combination, in patients with polycystic ovary syndrome. A clinical entity at high risk for developing diabetes mellitus and gestational diabetes: A pilot study

Abstract

Objective: To determine the efficacy of sitagliptin alone or in combination with metformin in women with polycystic ovary in terms of ovarian cyclicity, fertility and cardiometabolic profile compared to metformin alone. Rationale: polycystic ovarian syndrome (PCOS) affects a percentage of 5–10% of women of reproductive age worldwide and has a prevalence of 6.6% (95% CI: 2.3–10.9%) in Mexican women and most common cause of infertility in developed countries. Treatment with insulin sensitizing drugs (metformin and pioglitazone) has been shown to improve menstrual cyclicity and fertility in the metabolic profile with polycystic ovarian patients. Incretins and DPP-4 inhibitors have been shown to enhance pancreatic β cell activity, increasing weight loss by its anorexic effect and resulting in an adequate weight control and improved fertility. Previous evidence has compared the effect of exenatide and alone or in combination with metformin in the treatment of PCOS, in this article we will compare sitagliptin and metformin alone or in combination. Study design: Blind, controlled and randomized clinical trial. Patients: Women between 18 and 40 years of age, with a BMI >20 and diagnosed with PCOS with the Rotterdam criteria. Results: In the normalized index of menstruations it was found that there was a statistically significant intragroup increase in each one of the treatments. With a higher percentage of change, that of metformin with 80%, followed by that of sitagliptin with 65% and then COMBO with 30%. No statistically significant differences were found between treatment groups. Conclusion: Therapeutic effect of sitagliptin was observed in patients with PCOS comparable to metformin and the combination of metformin-sitagliptin is more effective in terms of ovulation than the other two treatments alone.

Keywords

• Polycystic ovarian syndrome
• Diabetes mellitus
• Prediabetes
• Insulin resistance