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World J Diabetes. Mar 15, 2022; 13(3): 129-149
Published online Mar 15, 2022. doi: 10.4239/wjd.v13.i3.129
Markers of insulin resistance in Polycystic ovary syndrome women: An update
Chantal Anifa Amisi
Chantal Anifa Amisi, Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Rome, Rome 00128, Italy
Author contributions: Chantal Amisi wrote the manuscript.
Conflict-of-interest statement: The author declares that she has no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chantal Anifa Amisi, MD, PhD, Doctor, Senior Researcher, Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Rome, via Alvaro del Portillo 21, Rome 00128, Italy.
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: July 15, 2021
Revised: September 14, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: March 15, 2022

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5%-10% of women of reproductive age. The importance of this syndrome lies in the magnitude of associated comorbidities: infertility, metabolic dysfunction, cardiovascular disease (CVD), plus psychological and oncological complications. Insulin resistance (IR) is a prominent feature of PCOS with a prevalence of 35%-80%. Without adequate management, IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS. Furthermore, epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance, gestational diabetes mellitus and type 2 diabetes. In addition, metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS. Indeed, the severity of IR in women with PCOS is associated with the amount of abdominal obesity, even in lean women with PCOS. Given these drastic implications, it is important to diagnose and treat insulin resistance as early as possible. Many markers have been proposed. However, quantitative assessment of IR in clinical practice remains a major challenge. The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp. However, it is not used routinely because of the complexity of its procedure. Consequently, there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations. Despite this, many of them are either difficult to apply in routine clinical practice or useless for women with PCOS. Considering this difficulty, there is still a need for an accurate marker for easy, early detection and assessment of IR in women with PCOS. This review highlights markers of IR already used in women with PCOS, including new markers recently reported in literature, and it establishes a new classification for these markers.

Keywords: Markers, Insulin resistance, Polycystic ovary syndrome, Emerging markers, Impaired glucose tolerance

Core Tip: Diagnosing insulin resistance in Polycystic ovary syndrome is of crucial importance for better management and prevention of complications. Seeking of an easy-to-detect surrogate marker of insulin resistance represents a promising approach for maximizing treatment outcomes. This review highlights markers of insulin resistance already used in women with Polycystic ovary syndrome, including new markers recently reported in literature, and establishes a new classification of them.