Figure 5.

Molecular mechanisms of anti-diabetic drugs

Pioglitazone, an agonist for PPAR-γ, reduces circulating FFA levels and inflammation cytokines while increasing adiponectin expression. DPP-4 inhibitors enhance GLP-1 function by inhibiting DPP-4, which promotes GLP-1 decomposition. Metformin can activate AMPK to inhibit ACC1/2 and SREBP-1c, leading to the suppression of de novo lipogenesis. GLP-1 RAs can enhance glucose-stimulated insulin secretion and protect pancreatic β cells. SGLT-2 inhibitors may induce hypoglycemic effects by inhibiting glucose reabsorption in the proximal renal tubule. These medications can improve endocrine and metabolic symptoms of PCOS by partly increasing insulin secretion, alleviating inflammation, and reducing androgen levels. Abbreviations: FFA, free fatty acid; PPAR, peroxisome proliferator-activated receptor; GLP-1, glucagon-like peptide 1; GLP-1 RA, Glucagon-like peptide-1 receptor agonist; DPP-4, dipeptidyl peptidase-4; SGLT2, sodium-glucose cotransporter 2; GLUT, glucose transporter; SREBP-1c, sterol regulatory element binding protein 1c; AMPK, AMP-activated protein kinase; mTOR, mammalian target of rapamycin; ACC, acetyl-CoA carboxylase; PCOS, polycystic ovary syndrome.