Recognizing the Role of Insulin Resistance in Polycystic Ovary Syndrome: A Paradigm Shift from a Glucose-Centric Approach to an Insulin-Centric Model

Polycystic ovary syndrome (PCOS) is a common metabolic-endocrine disorder affecting women of reproductive age, and insulin resistance (IR) is a key pathophysiological feature. Current medical education and clinical practice emphasize glucose-centric approaches in PCOS management, and IR testing is often overlooked due to inadequate knowledge or perceived lack of reliable assessment methods. Additionally, the glucose-focused paradigm has been the standard of care for decades. But this approach has led to delayed diagnosis of progressive metabolic and reproductive consequences, leaving many patients underdiagnosed and undertreated. Therefore, we propose a paradigm shift towards an insulin-centric model for PCOS management. This new approach aims to diagnose IR at an earlier stage enabling timely implementation of effective lifestyle and treatment strategies. By focusing on IR, clinicians can potentially limit the progression of PCOS-related reproductive and metabolic diseases. The insulin-centric model involves comprehensive IR screening, dynamic insulin testing, personalized lifestyle and insulin-sensitizing interventions, and regular monitoring of insulin and glycemic parameters. Adopting this paradigm in clinical practice could improve patient outcomes, offering a more proactive approach to managing PCOS and related metabolic disorders. Furthermore, this model has broader implications, potentially transforming treatment approaches for various chronic diseases beyond PCOS.