NR 505NP Week 3 Quantitative Research Collaboration Café

Sample Answer

PICOT Question

For females diagnosed with PCOS, how does the initiation of daily inositol supplementation affect insulin resistance evidenced by H1AC in comparison to PCOS females who utilize metformin within 12 months?

Article Website

1. https //reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01207-7Links to an external site.

Article Reference

Zhao, H., Xing, C., Zhang, J., & He, B. (2021). Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS a network meta-analysis. Reproductive health, 18(1), 1-12.

Description of the purpose

The purpose of this quantitative research is to determine if the improvement of insulin resistance in PCOS can be achieved by the implementation of comparing various insulin sensitizers including inositol and the effects on endocrine and metabolic profiles in women with PCOS.

Explanation of research design

The randomized controlled trial was composed of 1079 patients. These patients were divided into comparing PCOS patients utilizing inositol in comparison to metformin. The age ranged from women of 14-49 years of age diagnosed with PCOS. The trial was conducted and patients were followed for 12 weeks while measuring desired outcomes from the predefined categories of menstruation, hyperandrogenism, metabolism and insulin resistance. Within the study, they were focused on their lab result evaluation and emphasizing the parameters of total testosterone, sex hormone-binding globulin, androstenedione, glucolipid metabolism, fasting glucose, fasting insulin, homeostatic assessment of insulin resistance, lipids, total cholesterol, and BMI.

Discussion of sample

The sample was performed by 1079 women ages 14-49 that are diagnosed with PCOS. They used the PICO framework to identify relevant trials that support their research findings. Combinations of treatment such as metformin, thiazolidinediones, and inositol were implemented in order to identify the best medication or supplement that best supports reducing insulin resistance and other negative side effects of being diagnosed with PCOS. Out of the 1079 patients involved in the sample, 5 trials of 142 women were being evaluated with using inositol, 19 trials were conducted with 455 women with metformin, 10 trials with 280 regarding thiazolidinediones, 3 trials with 89 women utilizing metformin and thiazolidinediones, 1 trial of 26 women implemented berberine and 70 women used metformin and berberine in one trial while the remaining were the control group.

Description of data collection methods

The various treatment regimens were compared simultaneously using a pairwise meta-analysis. Pairwise meta-analysis is a method that pools evidence from randomized controlled trials that compare multiple interventions. In order to compare multiple interventions to each other, the estimates calculated were pooled estimates of mean differences or odd ratios with 95% confidence intervals. Outside of calculations, Stata software was also used to examine any research bias. As for network inconsistency, they were evaluated using node-splitting method and inconsistency models. The data that was being collected in order to determine effectiveness of treatment regimens were menstrual frequency, hyperandrogenism, obesity, glycometabolism, and lipid levels.

Summary of findings

In this study, the best intervention was determined by improving results within each category that was preselected to determine treatment efficacy. According to the meta-analysis menstrual frequency, hyperandrogenism, and glycometabolism were improved the best with inositol treatment. As for obesity and lipid levels, the research showed that there were no significant different. Based of this research’s findings, Inositol is deemed to be the best intervention in restoring regular menses and decreasing H1AC while improving insulin resistance. In comparison with metformin that has numerous side effects, inositol is described to have no side effects.

Strengths of the study

The strength of this study is being able to identify the comparative efficacy and safety of monotherapy versus combination of different oral insulin sensitizers. The strength of the study was being able to provide a comprehensive reference for clinical treatment for women with PCOS.

Limitations of the study

According to this article, this research has three limitations to the study, The first limitations is the very few reports met the criteria of treatment without contraceptives or intervention of ovulation inducing drugs. The second limitation was the different dosages, durations, and sample sizes of the various medications. Lastly, the third limitation was not accounting for the women who may have dropped out or missed a follow-up.

Recommendations regarding potential application for future practice that are insightful and appropriate.

Although, the study did not provide reliable and valid data in regard to identifying the clinical outcome of reducing H1AC in PCOS women implementing inositol, this research has started to find evidence towards the desired outcome. This research was able to identify and start the conversation of utilizing alternative supplements without the negative side effects such as the recommended first line of treatment, metformin.