Alternatives to glucophage for treating insulin resistance

For women with polycystic ovary syndrome - PCOS, insulin resistance is a common finding. In addition, many of these women do not respond to clomiphene citrate (Clomid resistance). For these reasons, many women are now treated with a diabetes medication known as glucophage (metformin) which works, in part, to reduce insulin resistance and improves the chances for ovulating spontaneously or with Clomid. However, many women will have side effects from glucophage such as bloating, cramping, diarrhea, flatulence and nausea. The most serious complication of glucophage is lactic acidosis which is a rare but potentially life threatening condition.

Acarbose is another medication used to treat diabetes. Acarbose is an alpha-Glycosidase inhibitor. It works by reducing the absorption of monosaccharides (simple sugars) through intestines and minimize the increase in blood sugar and insulin seen after meals. Serious side-effects of acarbose are rare and
although it shares many of the gastrointestinal side effects as glucophage, lactic acidosis is not a problem with this drug.

In a recent study, researchers looked at 30 women with polycystic ovary syndrome - PCOS who did not previously respond to clomid. The women were divided into two groups. One group received acarbose and clomid. The other group received glucophage and clomid.

By the end of three months, the women taking acarbose lost more weight than the glucophage group. Both groups showed a similar improvement in the number of women who ovulated. There were 15 women in each in group and they were studies for three months so there was a possibility of 45 ovulatory cycles (15 x 3). The acarbose group had 20 ovulations and the glucophage group had 24 ovulations. The incidence of side effects were the same in both groups and there were no serios adverse effects in either group.

In summary, it seems that acarbose could provide a reasonable alternative to glucophage for treating insulin resistance in polycystic ovary syndrome - PCOS patients, though the expected benefits are minimal. This was a small study so there isn't nearly as much data showing a positive effect as exists for glucophage at the moment. Acarbose did not have a better ovulation rate than glucophage so the main benefit comes down to a lower risk of lactic acidosis which is a very rare complication anyway.

I would think of acarbose as a second line drug for the time being. If first line drugs like glucophage or Actos or Avandia were not tolerated or ineffective than trying something like acarbose might be reasonable.