GLP1R and Insulin resistance: An obese PCOS patient displaying increased circulating EV miR-122 and miR-34a, alongside reduced EV miR-451 and heightened BMI/WHR ratios, may be classified within a high-risk cluster for hepatic steatosis with associated insulin resistance-induced reproductive dysfunction, warranting early combination therapy that includes metabolic modulation (e.g., GLP-1 agonists) and ovulatory support [206].