In general, the mechanisms of IGT and IR in patients with PCOS are complex, and a combination of hyperandrogenism, obesity, chronic inflammation, insulin signalling abnormalities and genetic factors contribute to the development of IGT and IR in patients with PCOS (Armanini et al., 2022; Dunaif, 1997; Hernández‐Jiménez et al., 2022; Macut et al., 2017). Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.