Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. Apart from menstrual disturbances and hyperandrogenism, PCOS is characterized by central obesity which leads to the disturbances of carbohydrate and lipid metabolism as well as the development of arterial hypertension. The profile of metabolic disturbances seen in women with PCOS is very similar to those seen in the metabolic syndrome (MS). The culprit in both is the insulin resistance and its ensuing hyperinsulinemia which in turn lead to the disturbances of carbohydrate metabolism. Therefore, the diagnosis of PCOS might also point to an increased risk of diabetes type 2 (T2DM) and cardiovascular disease development, which actually has been shown in several studies conducted in the last ten years. Thus, the pharmacological treatment of PCOS should not only concentrate on the alleviation of signs of hyperandrogenism and menstrual disturbances but also prevent the consequences of the existing metabolic disturbances. Insulin sensitizing drugs are commonly used in the treatment of women with PCOS not only to improve the existing metabolic dearrangements but also in the induction of ovulation. Nevertheless, non-pharmacologic strategies which improve insulin sensitivity such as weight loss, physical activity and restriction of foods with high glycemic index should be the first line of therapy in these women. This review presents recent advances in the diagnosis and the prevention of carbohydrate metabolism disorders in women with PCOS.