Comparison of the effects of dapagliflozin versus metformin in overweight and obese non-diabetic PCOS women – An interventional study

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TL;DR

This interventional study compared dapagliflozin to metformin in overweight/obese non-diabetic PCOS women. Dapagliflozin led to a significantly greater reduction in weight and BMI compared to metformin, while both drugs showed comparable improvements in metabolic parameters like fasting glucose and insulin resistance. The findings suggest dapagliflozin may be a promising non-inferior alternative to metformin for managing the metabolic component of PCOS, potentially expanding treatment options beyond diabetes.

Full summary

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**Background:** Polycystic ovarian syndrome (PCOS) is a common endocrinopathy associated with chronic anovulation, androgen excess, and long-term metabolic and cardiovascular consequences. Metformin is widely used to target insulin resistance and metabolic derangements in PCOS. The use of SGLT-2 inhibitors, such as dapagliflozin, is less explored in this population. This study aimed to compare the effects of dapagliflozin versus metformin on metabolic, anthropometric, and hormonal parameters in overweight and obese non-diabetic PCOS women.

**Methods:** This interventional study was conducted in the Endocrinology OPD at CARE Hospital, Hyderabad. A total of 25 patients were enrolled; 14 consented to receive metformin in combination with combined oral contraceptives (COCs), and 11 consented to receive dapagliflozin plus COCs. Baseline phenotypic, anthropometric, metabolic, and hormonal profiles were assessed. Patients were followed up after 3 months of treatment for repeat assessment.

**Key Results:** At follow-up, 10 patients in the metformin group and 8 in the dapagliflozin group had completed treatment. There was a significant decrease in weight and BMI in the dapagliflozin group compared to the metformin group. Both groups showed a comparable and significant decrease in waist and hip circumference. Regarding metabolic parameters, the reduction in fasting blood sugar (FBS), postprandial blood sugar (PBS), fasting insulin, and HOMA-IR was comparable between the groups. No significant change in hormonal parameters was observed in either group.

**Clinical Implications:** This study suggests that dapagliflozin is non-inferior to metformin in targeting the metabolic component of PCOS in overweight and obese non-diabetic women. Given the existing evidence of cardiovascular benefits with SGLT-2 inhibitors, this class of drugs may have an expanded role in PCOS management beyond diabetes. The significant weight loss observed with dapagliflozin could be particularly beneficial in this patient population. However, the small sample size and non-randomized design are limitations, and larger, randomized controlled trials are needed to confirm these findings and establish long-term safety and efficacy.