Endocrine Abstracts

Introduction: The role of metformin in PCOS is very well known and several studies reported effects of thiazolidinediones and SGLT2 inhibitors on metabolic parametars in these patients.

Objective: The aim of this study was to compare the effects of metformin, pioglitazone and empagliflozin treatment on metabolic control, hormonal imbalance, weight loss and ovulations in obese patients with PCOS and prediabetes.

Methods: BMI, waist circumference, HOMA index, leptin/adiponectin, LH/FSH, androstendione, testosterone, DHEAS, triglycerides, cholesterol, HDL, LDL and presense of ovulation were tested at the admission and 24 months after therapy.

Patients: 146 overweight/obese patients (mean age 25±2,6) with PCOS and prediabetes were divided in 3 groups based on medication they were treated with.

Results: Empagliflozin was superior to metformin in weight loss and metformin was superior than pioglitazone (P<0,05). Empagliflozin was superior to metformin and pioglitazone in reducing waist circumferences (P<0.01). Metformin was superior to empagliflozin and pioglitazone in lowering LH/FSH and testosterone (P<0,001). Metformin and empagliflozin were superior in reducing androstendione than pioglitazone (P<0,01). Empagliflozin and pioglitazone were superior to metformin in raising SHBG and HDL (P<0,01) and lowering L/A (P<0,05), trilgycerides (P<0,001) and HOMA index (P<0,01). There was no difference between groups in ovulatory menstrual cycles regulation.

Conclusions: Empagliflozin and pioglitazone were superior to metformin in metabolic control while metformin was superior in resolving hyperandrogenism. Metformin, pioglitazone and empagliflozin were equally efficient in regulating menstrual cycles in patients with PCOS Pioglitazone and empagliflozin can be a second therapy of choice in patients with PCOS.