Rationale of Insulin-Sensitizing Agents in the Treatment of Functional Bladder Disorders

Abstract

Recently, there has been increasing interest in the complex function of insulin, not only in its familiar role as a blood glucose-regulating hormone but also as a growth factor and biological regulator. This publication reviews the literature related to insulin resistance (IR) as a causative and exacerbating element in functional urological disorders, including overactive bladder syndrome (OAB). Patients with OAB or similar disorders often present with seemingly unrelated medical issues, such as metabolic syndrome (MetS), fibromyalgia (FM), psoriatic arthritis (PsA), and polycystic ovary syndrome (PCOS). However, these conditions interact with one another and can result in complex clinical scenarios. The literature reviewed delineates a pathophysiological circuit among these disorders, which share the chronic inflammation and underlying oxidative stress caused by IR. Growing evidence from both animal model studies and randomized clinical trials indicates that certain molecules, such as myo-inositol (MI), magnesium (Mg²⁺), folic acid (FoA), vitamin C (Vc), ferulic acid (FA), and vitamin D (Vd), are effective in treating functional bladder disorders and other syndromes linked to IR. Their success is attributable first and foremost to their insulin-sensitizing actions and, therefore, to their antioxidant and anti-inflammatory properties. Moreover, these treatments are generally safe and well-tolerated, whether used alone or in combination with existing therapies. Therefore, administering these substances to patients with conditions in which IR is known to be a key etiologic factor holds scientific justification and represents a promising therapeutic approach with potential future applications.