Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1318
Peer-review started: November 30, 2022
First decision: January 19, 2023
Revised: January 19, 2023
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 26, 2023
Processing time: 85 Days and 12 Hours
Insulin resistance (IR) is implicated in many aspects of polycystic ovarian syndrome (PCOS) pathogenesis. Metformin effectively decreased IR. Improved IR was evaluated via homeostatic model assessment for IR (HOMA-IR) and Doppler parameters; mainly carotid artery intima-media thickness (ICA-IMT). The area under the curve of the internal carotid artery (AUC-ICA) Doppler wave was examined as a helpful marker for determining IR among PCOS cases presented with menstrual irregularity and treated by metformin over 6 mo.
Much research has shown that surrogate measures of insulin sensitivity are no longer sufficient for evaluating insulin sensitivity, which has increased the need for new direct methods. Demonstrating changes in blood flow mirrored by AUC appeared to be more dependable; as indicated in earlier work, ICA-IMT was already examined in PCOS.
To ascertain if IR is related to the AUC-ICA Doppler in PCOS-affected women with menstrual irregularities. The second goal is to analyze the reliability of AUC-ICA as a helpful marker for monitoring IR in women who have received metformin treatment.
The study enrolled 54 PCOS women in a cross-sectional study. Anthropometric data included patient age, body mass index (BMI), menstrual cycle days, biochemical parameters: serum cholesterol, low and high-density lipoprotein, sex hormone-binding globulin, fasting blood glucose, and HOMA-IR, hormonal parameters: testosterone, luteinizing hormone over follicle-stimulating hormone ratio, and ultrasonic parameters: (CIMT, PI, RI, and AUC-ICA). Measurements of the systolic and diastolic wave height were repeated in order to evaluate the AUC-ICA following metformin tab-500 mg; three times/d for 6 mo. Metformin caused a progressive reduction in BMI, menstrual cycle days, biochemical hormonal, and Doppler parameters (CIMT, PI, RI, and AUC-ICA). AUC-ICA correlated strongly to all PCOS parameters. AUC-ICA correlated inversely with treatment time (r = -0.98, P < 0.001) and positively with HOMA-IR (r = 0.98, P < 0.0001). Via the best subset regression model, the AUC-ICA had the highest predictive value for HOMA-IR.
BMI, menstrual cycle days, biochemical hormonal, and Doppler markers (CIMT, PI, RI, and AUC-ICA were all gradually reduced by metformin treatment). All PCOS indicators and AUC-ICA had significant correlations. AUC-ICA had a negative correlation (r = -0.98, P < 0.001) with treatment time and a positive correlation (r = 0.98, P0.0001) with HOMA-IR. The AUC-ICA demonstrated the best subset regression model's maximum predictive value for HOMA-IR.
AUC-ICA was a reliable marker for the assessment of IR, especially during metformin medication. AUC-ICA preceded PI, RI, and CIMT and showed a high, meaningful correlation to other PCOS markers. For further use in practice, more research is suggested.
The area under the curve of the internal carotid artery had a significant correlation with HOMA-IR and the length of metformin therapy, not to mention it has a superior cost-benefit analysis over HOMA-IR. AUC-ICA is a reliable indicator of IR, follow-up, and prognostic value, particularly while using metformin.