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Belsti Y, Enticott J, Azumah R, Tay CT, Moran L, Ma RCW, Joham AE, Laven J, Teede H, Mousa A. Diagnostic accuracy of oral glucose tolerance tests, fasting plasma glucose and haemoglobin A1c for type 2 diabetes in women with polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes Metab Syndr 2024; 18:102970. [PMID: 38442646 DOI: 10.1016/j.dsx.2024.102970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
AIMS To inform international guidelines, a systematic review and meta-analysis was conducted to assess the performance of diagnostic methods for type 2 diabetes in women with polycystic ovary syndrome (PCOS). METHODS An updated systematic search was conducted on five databases from 2017 until October 2023 and combined with prior searches (from inception). Meta-analyses of diagnostic accuracy tests were conducted. RESULTS Nine studies comprising 2628 women with PCOS were included. Against the oral glucose tolerance test, a haemoglobin A1C (HbA1c) ≥ 6.5% had a pooled sensitivity of 50.00% (95% confidence interval (CI): 35.53-64.47), specificity of 99.86% (95%CI: 99.49-99.98), and positive and negative predictive values of 92.59% (95%CI: 75.27-98.09) and 98.27% (95%CI: 97.73-98.68), respectively, with an accuracy of 98.17% (95%CI: 97.34-98.79). Fasting plasma glucose values ≥ 7.0 mmol/L had a pooled sensitivity of 58.14% (95%CI: 42.13-72.99), specificity of 92.59% (95%CI: 75.35-98.08), positive and negative predictive values of 92.59% (95%CI: 75.35-98.08) and 99.09% (95%CI: 98.71-99.36), respectively, and an accuracy of 99.00% (95%CI: 98.46-99.39) against the oral glucose tolerance test. CONCLUSIONS To our knowledge, this is the first systematic review assessing the performance of diagnostic methods for type 2 diabetes in women with PCOS. We demonstrate that using a cut-off for HbA1c of ≥6.5% in this population may result in misdiagnosis of half of the women with type 2 diabetes. Our results directly informed the recommendations of the 2023 International PCOS Guideline, suggesting that the oral glucose tolerance test is the optimal method for screening and diagnosing type 2 diabetes in women with PCOS and is superior to fasting plasma glucose and HbA1c.
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Affiliation(s)
- Yitayeh Belsti
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rafiatu Azumah
- Robinson Research Institute, The University of Adelaide AHMS Building, North Terrace, Adelaide, South Australia, 5005, Australia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronald C W Ma
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, China
| | - Anju E Joham
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Diabetes and Endocrine Units, Monash Health, Melbourne, Victoria, 3168, Australia
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Diabetes and Endocrine Units, Monash Health, Melbourne, Victoria, 3168, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Melo RH, Pontes AG, Delmanto LRMG, Bueloni-Dias FN, Vespoli HDL, Nahas EAP. The role of glycated hemoglobin in the diagnosis of prediabetes and diabetes mellitus in young women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2024; 100:124-131. [PMID: 37828797 DOI: 10.1111/cen.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/19/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To compare glycated hemoglobin (HbA1c) and the oral glucose tolerance test (OGTT) for the diagnosis of prediabetes and diabetes in young women with polycystic ovary syndrome (PCOS). PATIENTS AND DESIGN This cross-sectional study included 154 women aged 20-40 years with a diagnosis of PCOS, who were screened for prediabetes and diabetes by the OGTT and HbA1c. Women with diabetes, hyperprolactinemia, thyroid or adrenal diseases, and anemia and users of hormonal contraception or corticosteroids were excluded. MEASUREMENTS Clinical, biochemical and ultrasound data were collected from the electronic medical records. The women were classified as having normal glucose metabolism, prediabetes, or diabetes based on the diagnostic tests. Sensitivity and specificity were calculated and the Kappa method was used to assess agreement between the two methods. RESULTS According to the OGTT and HbA1c values, 79.2% and 76% of the women were within the normal range, respectively, 16.8% and 19.5% had prediabetes, and 4% and 4.5% had diabetes (p > .05). The Kappa coefficient of 0.41 (95% confidence interval: 0.24-0.58) indicated medium agreement between methods. Considering the OGTT as the gold standard, the specificity of HbA1c was 89.5% and sensitivity was 85.7% in the diagnosis of prediabetes and 100% and 66.7%, respectively, in the diagnosis of diabetes. CONCLUSION The HbA1c, when compared to the OGTT, showed high sensitivity and specificity in the diagnosis of prediabetes in young women with PCOS.
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Affiliation(s)
- Raissa Holanda Melo
- Graduate Program in Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Ana Gabriela Pontes
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | | | - Flavia Neves Bueloni-Dias
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Heloisa De Luca Vespoli
- Graduate Program in Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Eliana Aguiar Petri Nahas
- Graduate Program in Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
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Livadas S, Paparodis R, Anagnostis P, Gambineri A, Bjekić-Macut J, Petrović T, Yildiz BO, Micić D, Mastorakos G, Macut D. Assessment of Type 2 Diabetes Risk in Young Women with Polycystic Ovary Syndrome. Diagnostics (Basel) 2023; 13:2067. [PMID: 37370962 DOI: 10.3390/diagnostics13122067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Women with polycystic ovary syndrome (PCOS) are at increased risk for dysglycemia and type 2 diabetes compared to healthy BMI-matched women of reproductive age: robust evidence exists supporting this notion. The presence of altered glycemic status in young women with the syndrome presents a distinct challenge for the clinician for several reasons. Firstly, the reported incidence of this disorder varies among the limited available studies. Furthermore, there is a lack of consensus on the best screening method, which women to screen, at what frequency, and which strategies need to be implemented to reduce the above risk. We provide data regarding the prevalence of dysglycemia in young women suffering from PCOS and the pathophysiological mechanisms underlying the disorder. In addition, we present evidence suggesting universal screening with the oral glucose tolerance test in young women with the syndrome, irrespective of age or BMI status, to identify and manage glycemic abnormalities in a timely manner. Regarding follow-up, oral glucose testing should be carried out at regular intervals if there are initial abnormal findings or predisposing factors. Finally, the efficacy of a well-balanced diet in conjunction with regular exercise and the use of non-pharmacologic agents in this specific population is discussed.
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Affiliation(s)
| | - Rodis Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 57429 Thessaloniki, Greece
| | - Alessandra Gambineri
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy
| | - Jelica Bjekić-Macut
- Department of Endocrinology, UMC Bežanijska kosa, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tijana Petrović
- Department of Endocrinology, UMC Bežanijska kosa, 11080 Belgrade, Serbia
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Dragan Micić
- Department of Medical Sciences, Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Livadas S, Bothou C, Kuliczkowska-Płaksej J, Robeva R, Vryonidou A, Macut JB, Androulakis I, Opalic M, Mouslech Z, Milewicz A, Gambineri A, Panidis D, Macut D. Can dysglycemia in OGTT be predicted by baseline parameters in patients with PCOS? Endocr Connect 2022; 11:e210358. [PMID: 35258478 PMCID: PMC9066574 DOI: 10.1530/ec-21-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is considered a risk factor for the development of type 2 diabetes mellitus (T2DM). However, which is the most appropriate way to evaluate dysglycemia in women with PCOS and who are at increased risk are as yet unclear. Aim of the study To determine the prevalence of T2DM, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in PCOS women and potential factors to identify those at risk. Subjects and methods The oral glucose tolerance test (OGTT), biochemical/hormonal profile, and ovarian ultrasound data from 1614 Caucasian women with PCOS and 362 controls were analyzed in this cross-sectional multicenter study. The data were categorized according to age and BMI. Results Dysglycemia (T2DM, IGT, and IFG according to World Health Organization criteria) was more frequent in the PCOS group compared to controls: 2.2% vs 0.8%, P = 0.04; 9.5% vs 7.4%, P = 0.038; 14.2% vs 9.1%, P = 0.002, respectively. OGTT was essential for T2DM diagnosis, since in 88% of them basal glucose values were inconclusive for diagnosis. The presence of either T2DM or IFG was irrespective of age (P = 0.54) and BMI (P = 0.32), although the latter was associated with IGT (P = 0.021). There was no impact of age and BMI status on the prevalence of T2DM or IFG. Regression analysis revealed a role for age, BMI, fat deposition, androgens, and insulin resistance for dysglycemia. However, none of the factors prevailed as a useful marker employed in clinical practice. Conclusions One-third of our cohort of PCOS women with either T2DM or IGT displayed normal fasting glucose values but without confirming any specific predictor for dysglycemic condition. Hence, the evaluation of glycemic status using OGTT in all women with PCOS is strongly supported.
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Affiliation(s)
| | - Christina Bothou
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | | | - Ralitsa Robeva
- Ushate ‘acad. IV. Penchev’, Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, Sofia, Bulgaria
| | - Andromahi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Jelica Bjekic Macut
- Department of Endocrinology, UMC Bežanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Milica Opalic
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zadalla Mouslech
- 1st Medical Propedeutic, Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrej Milewicz
- Department of Endocrinology, Diabetology and Isotope Therapy, University of Medicine, Wrocław, Poland
| | - Alessandra Gambineri
- Department of Medical and Surgical Science-DIMEC Endocrinology Unit, University of Bologna – S. Orsola-Mapighi Hospital, Italy
| | - Dimitrios Panidis
- Gynaecological Endocrinology Infirmary of the Second Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Djuro Macut
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: An update. World J Diabetes 2022; 13:129-149. [PMID: 35432749 PMCID: PMC8984569 DOI: 10.4239/wjd.v13.i3.129] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/14/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5%-10% of women of reproductive age. The importance of this syndrome lies in the magnitude of associated comorbidities: infertility, metabolic dysfunction, cardiovascular disease (CVD), plus psychological and oncological complications. Insulin resistance (IR) is a prominent feature of PCOS with a prevalence of 35%-80%. Without adequate management, IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS. Furthermore, epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance, gestational diabetes mellitus and type 2 diabetes. In addition, metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS. Indeed, the severity of IR in women with PCOS is associated with the amount of abdominal obesity, even in lean women with PCOS. Given these drastic implications, it is important to diagnose and treat insulin resistance as early as possible. Many markers have been proposed. However, quantitative assessment of IR in clinical practice remains a major challenge. The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp. However, it is not used routinely because of the complexity of its procedure. Consequently, there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations. Despite this, many of them are either difficult to apply in routine clinical practice or useless for women with PCOS. Considering this difficulty, there is still a need for an accurate marker for easy, early detection and assessment of IR in women with PCOS. This review highlights markers of IR already used in women with PCOS, including new markers recently reported in literature, and it establishes a new classification for these markers.
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Affiliation(s)
- Chantal Anifa Amisi
- Endocrinology and Diabetes Unit, Department of Medicine, Universita Campus Bio-medico di Rome, Rome 00128, Italy
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Livadas S, Anagnostis P, Bosdou JK, Bantouna D, Paparodis R. Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review. World J Diabetes 2022; 13:5-26. [PMID: 35070056 PMCID: PMC8771268 DOI: 10.4239/wjd.v13.i1.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities, such as insulin resistance. However, due to methodological flaws in the available studies and the multifaceted nature of the syndrome, there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated. The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS, the unique pathophysiological mechanisms underlying the progression of dysglycemia, the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population, as well as T2D risk after transition to menopause. Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided. Specifically, adoption of a healthy lifestyle with adherence to improved dietary patterns, such the Mediterranean diet, avoidance of consumption of endocrine-disrupting foods and beverages, regular exercise, and the effect of certain medications, such as metformin and glucagon-like peptide 1 receptor agonists, are discussed. Furthermore, the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.
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Affiliation(s)
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Dimitra Bantouna
- Department of Pathology and Cytology, University of Patras School of Medicine, Patras 10563, Greece
| | - Rodis Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH 23456, United States
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Kim N, Chun S. Association between the serum estrone-to-estradiol ratio and parameters related to glucose metabolism and insulin resistance in women with polycystic ovary syndrome. Clin Exp Reprod Med 2021; 48:374-379. [PMID: 34875745 PMCID: PMC8651759 DOI: 10.5653/cerm.2021.04553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Objective We aimed to evaluate associations between the ratio of serum estrone (E1) to estradiol (E2) and parameters related to serum glucose metabolism and insulin resistance in women with polycystic ovary syndrome (PCOS). Methods In total, 133 women between the ages of 18 and 35 diagnosed with PCOS were enrolled in this study. All participants with PCOS underwent blood tests to determine hormonal and biochemical metabolic parameters and a standard 2-hour 75-g oral glucose tolerance test. They were divided into two groups according to the serum E1-to-E2 ratio: group 1 (E1/E2 ratio <2.0) and group 2 (E1/E2 ratio ≥2.0). Results In the comparative analysis, the waist-to-hip ratio (WHR) was the only clinical variable that was significantly different between the two groups. Patients with a higher E1/E2 ratio showed higher fasting insulin levels, homeostasis model for insulin resistance, and postprandial glucose level at 2 hours (PPG2). In a correlation analysis, only PPG2 was significantly related to the serum E1/E2 ratio. However, after controlling for the confounding effects of body mass index (BMI) and WHR, fasting glucose was also significantly correlated with the serum E1/E2 ratio. Conclusion Women with PCOS with a higher serum E1/E2 ratio were found to be more likely to show higher fasting insulin and postprandial glucose levels. Significant correlations were found between the serum E1/E2 ratio and both fasting and postprandial serum glucose levels after adjusting for BMI and WHR in women with PCOS.
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Affiliation(s)
- Nayoung Kim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sungwook Chun
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Fruzzetti F, Baldari F, Palla G, Fidecicchi T, Carmina E. Comparison of PCOS phenotypes in adolescent and young adult Mediterranean women with possible PCOS. J Endocrinol Invest 2021; 44:995-1000. [PMID: 32839937 DOI: 10.1007/s40618-020-01394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE During adolescence, PCOS features are supposed to be in evolution. Because of this, the diagnosis of PCOS in adolescence is often unclear and few studies have compared adolescent and adult PCOS phenotype distribution and features. The aim is to compare phenotypes in adolescents and young adults with PCOS. METHODS 109 girls aged from 13 to 19 years were retrospectively studied. All patients had a gynecological age > 2 years. 63 patients were adolescents (3-5 years beyond menarche) while 46 patients were young adults (6-9 years beyond menarche). Diagnosis of different PCOS phenotypes (A, B, C, D) was made according to the Rotterdam criteria. Clinical data (menstrual cycles, BMI, presence of hirsutism), androgen circulating levels (total testosterone, androstenedione, dehydroepiandrosterone sulphate) and ovarian morphology by ultrasound were assessed. RESULTS 109 patients presented PCOS according to the Rotterdam criteria. Phenotype A was by far the most common phenotype (73.4%) followed by phenotype B (21.1%). Only few patients had phenotype C (4.6%) or phenotype D (0.9%). When patients were divided in two groups (adolescent and young adult patients), no significant difference in prevalence and features of the different phenotypes was observed. CONCLUSION In this cohort of adolescent and young adult women with PCOS, the progression of age does not change the prevalence and the features of main PCOS phenotypes. It suggests that the Rotterdam criteria might be used also in adolescents, at least in those with 2 or more years of gynecological age, for the diagnosis of PCOS.
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Affiliation(s)
- F Fruzzetti
- Department of Obstetrics and Gynecology, Ospedale Santa Chiara, University of Pisa, Via Roma 35, 56100, Pisa, Italy.
| | - F Baldari
- Department of Obstetrics and Gynecology, Ospedale Santa Chiara, University of Pisa, Via Roma 35, 56100, Pisa, Italy
| | - G Palla
- Department of Obstetrics and Gynecology, Ospedale Santa Chiara, University of Pisa, Via Roma 35, 56100, Pisa, Italy
| | - T Fidecicchi
- Department of Obstetrics and Gynecology, Ospedale Santa Chiara, University of Pisa, Via Roma 35, 56100, Pisa, Italy
| | - E Carmina
- Department of Endocrinology, Medical School of Palermo University, University of Palermo, Palermo, Italy
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Carmina E, Nasrallah MP, Guastella E, Lobo RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clin Endocrinol (Oxf) 2019; 91:553-560. [PMID: 31306504 DOI: 10.1111/cen.14063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To better characterize the metabolic alterations in various phenotypes of polycystic ovary syndrome (PCOS) in a large homogeneous (Sicilian) Mediterranean population with a low prevalence of obesity. DESIGN Retrospective study. PATIENTS A total of 1215 consecutively evaluated women with PCOS divided into four Rotterdam phenotypes (A, B, C and D) and in 108 matched ovulatory, nonhyperandrogenic women. MEASUREMENTS BMI, fasting glucose, total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol and an oral glucose tolerance test. RESULTS The overall prevalence of obesity was 31%, metabolic syndrome 6.6%, diabetes 2.1%, altered glucose metabolism 13.1%, and abnormal lipid profile 60%. Phenotype B had the highest prevalence of obesity, metabolic syndrome, altered glucose metabolism and lipid abnormalities compared to other PCOS phenotypes and controls. Phenotype A was more obese and more women had metabolic syndrome compared to phenotypes C and D but phenotype C had a similar prevalence of altered glucose metabolism and lipid abnormalities compared to phenotype A which had a higher BMI. These metabolic abnormalities in A and C were higher compared to phenotype D and controls. Multivariate analysis showed that BMI predicts only abnormalities in fasting glucose and triglycerides, while there was no association with androgens. CONCLUSIONS In Mediterranean women with PCOS from Sicily with a lower prevalence of obesity, the prevalence of diabetes, altered glucose metabolism and metabolic syndrome were much lower than reported in US studies. Phenotype B was the most metabolically affected phenotype, followed by phenotype A. Phenotype C had an intermediate disorder but with a high prevalence of altered glucose metabolism and lipid alterations. Only the normoandrogenic phenotype D had no metabolic abnormalities.
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Affiliation(s)
- Enrico Carmina
- Department of Health Sciences, Child and Mother Care, and General and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Mona P Nasrallah
- Department of Internal Medicine, Endocrinology and Metabolism, American University of Beirut, Beirut, Lebanon
| | - Ettore Guastella
- Department of Health Sciences, Child and Mother Care, and General and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Rogerio A Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent disorder, representing the single most common endocrine-metabolic disorder in reproductive-aged women. Currently there are four recognized phenotypes of PCOS: 1) hyperandrogenism+oligo-anovulation+polycystic ovarian morphology; 2) hyperandrogenism+oligo-anovulation; 3) hyperandrogenism+polycystic ovarian morphology; and 4) oligo-anovulation+polycystic ovarian morphology, each with different long-term health and metabolic implications. Clinicians should clearly denote a patient's phenotype when making the diagnosis of PCOS. Polycystic ovary syndrome is a highly inherited complex polygenic, multifactorial disorder. Pathophysiologically abnormalities in gonadotropin secretion or action, ovarian folliculogenesis, steroidogenesis, insulin secretion or action, and adipose tissue function, among others, have been described in PCOS. Women with PCOS are at increased risk for glucose intolerance and type 2 diabetes mellitus; hepatic steatosis and metabolic syndrome; hypertension, dyslipidemia, vascular thrombosis, cerebrovascular accidents, and possibly cardiovascular events; subfertility and obstetric complications; endometrial atypia or carcinoma, and possibly ovarian malignancy; and mood and psychosexual disorders. The evaluation of patients suspected of having PCOS includes a thorough history and physical examination, assessment for the presence of hirsutism, ovarian ultrasonography, and hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders. Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility. However, despite significant progress in understanding the pathophysiology and diagnosis of the disorder over the past 20 years, the disorder remains underdiagnosed and misunderstood by many practitioners.
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Kawa IA, Masood A, Ganie MA, Fatima Q, Jeelani H, Manzoor S, Rizvi SM, Muzamil M, Rashid F. Bisphenol A (BPA) acts as an endocrine disruptor in women with Polycystic Ovary Syndrome: Hormonal and metabolic evaluation. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.obmed.2019.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Ortiz-Flores AE, Luque-Ramírez M, Fernández-Durán E, Alvarez-Blasco F, Escobar-Morreale HF. Diagnosis of disorders of glucose tolerance in women with polycystic ovary syndrome (PCOS) at a tertiary care center: fasting plasma glucose or oral glucose tolerance test? Metabolism 2019; 93:86-92. [PMID: 30710572 DOI: 10.1016/j.metabol.2019.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The risk of developing prediabetes and type 2 diabetes (dysglycemia) may be increased in women with PCOS. Whether an oral glucose tolerance test (OGTT) should be performed routinely in all PCOS women at presentation or should be recommended only to a selected subset of patients is still controversial. BASIC PROCEDURES At a tertiary care center, we conducted a retrospective, observational study including 400 women with PCOS submitted to an OGTT. Our primary objective was to assess the diagnostic agreement between two algorithms commonly used for the screening of dysglycemia in these women: i) relying only on fasting plasma glucose (FPG) or ii) considering both fasting and/or 120-min plasma glucose concentrations during an OGTT. We conducted the analysis considering all patients as a whole, and also after stratifying them by body weight, androgen concentrations and age. MAIN FINDINGS The OGTT detected dysglycemia in 24.5% of patients, whereas only 14.3% women would have been diagnosed using FPG levels alone. The latter missed as many as 40% of women with dysglycemia in our series, including all cases of diabetes. Diagnostic agreement between both algorithms was only 0.55 (κ = 0.103; 95% CI: 0.05-0.16). Areas under the receiver operating characteristic curve for dysglycemia were 0.86 (95%CI: 0.81-0.91) for FPG and 0.91 (95%CI = 0.87-0.95) for 120-min plasma glucose during the OGTT. FPG was not accurate in predicting dysglycemia in women with PCOS regardless of the presence of insulin resistance, weight excess, hyperandrogenemia and age. PRINCIPAL CONCLUSIONS Relying on FPG alone is not adequate for the screening of disorders of glucose tolerance in women with PCOS; such diagnosis should rely on the results of an OGTT regardless of age, weight and/or androgen concentrations.
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Affiliation(s)
- Andrés E Ortiz-Flores
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28034, Spain
| | - Manuel Luque-Ramírez
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28034, Spain
| | - Elena Fernández-Durán
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28034, Spain
| | - Francisco Alvarez-Blasco
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28034, Spain
| | - Héctor F Escobar-Morreale
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, 28034, Spain.
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13
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Shapiro AJ, Holden EC, McGovern PG, Alderson D, Morelli SS. Comparison of 2-Hour Oral Glucose Tolerance Test and Hemoglobin A1C in the Identification of Pre-Diabetes in Women with Infertility and Recurrent Pregnancy Loss. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119831280. [PMID: 30923441 PMCID: PMC6431759 DOI: 10.1177/1179558119831280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 12/16/2022]
Abstract
RESEARCH QUESTION Does hemoglobin A1C (HbA1C) predict pre-diabetes (pre-DM) in a population of women with infertility and/or recurrent pregnancy loss (RPL), when considering the 75 g, 2-hour oral glucose tolerance test (2h GTT) as the gold standard? DESIGN Retrospective study of 242 patients with infertility or RPL presenting to a university-affiliated reproductive endocrinology and infertility clinic between January 2012 and December 2016 who underwent screening for disorders of glucose metabolism with a 2h GTT. The prevalence of pre-DM as defined by HbA1C 5.7% to 6.4% and 2h GTT values of 140-199 mg/dL, and predictive values of HbA1C for the identification of pre-DM when compared with 2h GTT, were calculated and compared. RESULTS Of 242 patients, 188 (77.7%) women had both HbA1C and 2h GTT performed. Of these, 89 (47.3%) tested positive for pre-DM by one or both methods. Of 89 patients, 14 (15.7%) had both an abnormal 2h GTT and an abnormal HbA1C. Only 6 out of 89 (6.7%) patients tested positive for pre-DM by an abnormal 2h GTT in the setting of a normal HbA1C result. Conversely, 69 of these 89 patients (77.5%) tested positive for pre-DM by an abnormal HbA1C in the setting of a normal 2h GTT. The prevalence of pre-DM, as defined by 2h GTT, was 10.6% (20/188) (95% CI, 6.6-16.0), compared with a prevalence of 44.1% (83/188) (95% CI, 36.9-51.6) when pre-DM was defined by HbA1C alone. When the 2h GTT was considered the gold standard for the identification of pre-DM, the negative predictive value (NPV) of HbA1C compared with 2h GTT was 94.3% (95% CI, 88.0-97.9), whereas the positive predictive value (PPV) of HbA1C compared with 2h GTT was only 16.9% (95% CI, 9.5-26.7). CONCLUSIONS Although a normal HbA1C was highly predictive of a normal 2h GTT, the two tests demonstrate poor agreement in the identification of pre-DM in women with infertility and/or RPL. Hemoglobin A1C is superior to the 2h GTT as an initial screening test for pre-DM in this population, since it identified a substantial number of women who would otherwise remain undiagnosed in the setting for a normal 2h GTT alone. However, the long-term clinical relevance of an elevated HbA1C in this population needs to be better defined.
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Affiliation(s)
- Alice J Shapiro
- Department of Obstetrics, Gynecology and Women’s Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Emily C Holden
- Department of Obstetrics, Gynecology and Women’s Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter G McGovern
- Department of Obstetrics, Gynecology and Women’s Health, Rutgers New Jersey Medical School, Newark, NJ, USA
- University Reproductive Associates, Hasbrouck Heights, NJ, USA
| | - Donald Alderson
- Rutgers University Biostatistics and Epidemiology Services Center, Rutgers University, Piscataway, NJ, USA
| | - Sara S Morelli
- Department of Obstetrics, Gynecology and Women’s Health, Rutgers New Jersey Medical School, Newark, NJ, USA
- University Reproductive Associates, Hasbrouck Heights, NJ, USA
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Cree-Green M, Cai N, Thurston JE, Coe GV, Newnes L, Garcia-Reyes Y, Baumgartner AD, Pyle L, Nadeau KJ. Using simple clinical measures to predict insulin resistance or hyperglycemia in girls with polycystic ovarian syndrome. Pediatr Diabetes 2018; 19:1370-1378. [PMID: 30246333 PMCID: PMC6400639 DOI: 10.1111/pedi.12778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/09/2018] [Accepted: 09/09/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) includes insulin resistance (IR) and impaired glucose tolerance (IGT) in youth, and a greatly elevated risk of type 2 diabetes in adulthood. Identifying IR is challenging and documenting IGT requires an oral glucose tolerance test (OGTT). OBJECTIVE Identify easily applied surrogate measures for IR and IGT in girls with PCOS. METHODS We studied 28 girls with PCOS (body mass index [BMI] percentile 98 (83.99); 15.5 (14.5,16.6) years of age) and 20 with normal menses [BMI percentile (97 (88.99); 15.5 (13.3,16.1) years]. Hyperinsulinemic-euglycemic clamps (insulin dose of 80 μU/ml/min) to determine glucose infusion rate (GIR) and a 75 g OGTT were performed. Surrogates for IR including fasting insulin, homeostatic model assessment-insulin resistant (HOMA-IR), Matsuda index, and estimate of insulin sensitivity (e-IS) were compared to IGT status and GIR. Spearman correlations were performed between surrogates and GIR or IGT, and receiver operator curve (ROC) analysis to predict GIR below the median or IGT status. RESULTS GIR was lower in PCOS (12.9 ± 4.6 vs 17.1 ± 5.1 mg/kg fat-free mass·min; P = 0.01). Within PCOS, HOMA-IR (r = -0.78, P < 0.0001), e-IS (r = 0.70, P < 0.001), and Matsuda (r = 0.533, P < 0.001) correlated with GIR. e-IS provided a good sensitivity (100%) and specificity (71%) to identify IR (e-IS cutoff: <6.3, ROC-area under curve = 0.898). Fasting insulin >22 IU/mL had the best sensitivity (88%), specificity (78%), and ROC (0.760) for IGT status. CONCLUSIONS Girls with PCOS have significant IR, and IGT is common. Both e-IS and fasting insulin are obtainable without an OGTT or clamp and could be used clinically to guide treatment in PCOS.
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Affiliation(s)
- Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women’s Health Research, Aurora, CO
| | - Ninghe Cai
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jessica E. Thurston
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Gregory V. Coe
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lindsay Newnes
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Yesenia Garcia-Reyes
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy D. Baumgartner
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Kristen J. Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women’s Health Research, Aurora, CO
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15
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Malini NA, Roy George K. Evaluation of different ranges of LH:FSH ratios in polycystic ovarian syndrome (PCOS) - Clinical based case control study. Gen Comp Endocrinol 2018; 260:51-57. [PMID: 29273352 DOI: 10.1016/j.ygcen.2017.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 10/11/2017] [Accepted: 12/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine and metabolic disorder among reproductive aged women, leading to infertility. One of the common clinical manifestations in PCOS is that there is a difference in the range of LH production in different case of PCOS and accordingly variability in LH:FSH ratio was observed. OBJECTIVE The aim of the present study was to evaluate different ranges of LH:FSH ratios in PCOS. EXPERIMENTAL DESIGN In this cross sectional study, a consecutive series of 745 women (aged 28.11 ± 0.2) who were subjected to infertility treatment at specialist infertility clinics in central Travancore region were considered. About 50 healthy females (aged 27.58 ± 0.4) with regular menstrual cycles were regarded as control. The data were collected from hospital records using subject's written informed consent. RESULTS PCOS patients were observed to have different ranges of LH:FSH ratios from < 1 range to 4.6-5.5 and subjects were classified into 7 PCO subgroups on the basis of their LH:FSH ratios. In whole PCO group, body weight, LH, FSH, LH:FSH ratio, insulin, HbA1c, estradiol, testosterone and TSH were significantly (P < .05) increased whereas progesterone and SHBG levels were significantly (P < .05) decreased in comparison to control. In various PCO subgroups as LH levels and LH:FSH ratios were increased, levels of insulin, testosterone and AMH were increased and SHBG levels were decreased accordingly. CONCLUSION This finding suggested a dependence of insulin, LH and testosterone in initiating the hormonal imbalances in PCOS.
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Affiliation(s)
- N A Malini
- Research Scholar, Post Graduate & Research Dept. of Zoology, St. Thomas College Kozhencherry-689641, Kerala, India.
| | - K Roy George
- Head, Assistant Professor & Research Guide, Post Graduate & Research Dept. of Zoology, St. Thomas College Kozhencherry-689641, Kerala, India.
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16
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de Medeiros SF. Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome. Reprod Biol Endocrinol 2017; 15:93. [PMID: 29216881 PMCID: PMC5721684 DOI: 10.1186/s12958-017-0313-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome. Because the combined oral contraceptive (COC) use has also been associated with impaired fasting glucose, insulin resistance and increased risk of thromboembolism disease, it is rationale to think that the combination of oral contraceptive and PCOS could make it worse or increase the risks. OBJECTIVE To examine the current data regarding potential additional risks and benefits of contraceptive use, highlights the major gap in knowledge for designing future studies and, when possible, suggests an adequate COC formulation for a determined PCOS phenotype. METHODS English-language publications reporting on the influence of COCS in the development of venous thromboembolism in PCOS patients published until 2017 were searched using PubMed, Cochrane database, and hand search of references found in consulted articles. Ranges of collected data are given; the pooled data are presented as median and first and third quartiles. Wilcoxon signed-ranks test for paired samples was used to compare before-after original data. P value was set at 0.05. RESULTS Most of COCs preparations significantly decrease androgens, and increase sex-hormone binding globulin. Therefore, the benefits of COCs are clear in patients with proved hyperandrogenemia. Regarding the impact of COCs on carbohydrate metabolism of PCOS subjects, the data were inconsistent but they tended to show no additional risk. Regarding lipids, most COCs consistently increased high-density lipoprotein cholesterol, triglycerides and total cholesterol concentrations but the clinical implications of these changes need additional studies. CONCLUSION The review showed consistent beneficial effect of COCs, particularly for hyperandrogenemic PCOS patients. The benefit size of COC's use by normoandrogenemic PCOS patients is uncertain and need more investigation. The effects of COC use on carbohydrate metabolism of women with PCOS are still unresolved since most studies are observational but the current results demonstrated that COCs do not make their levels worse and may improve insulin sensitivity. The impact of COCs on lipids of PCOS patients seems to be clearer and most preparations increase total cholesterol, high-density lipoprotein cholesterol and triglycerides. In summary, it is important to balance the potential benefits and risks of the COCs individually before prescribing them for PCOS women.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, MT, 78055-728, Brazil.
- Tropical Institute of Reproductive Medicine, Cuiabá, MT, Brazil.
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17
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Glintborg D, Andersen M. MANAGEMENT OF ENDOCRINE DISEASE: Morbidity in polycystic ovary syndrome. Eur J Endocrinol 2017; 176:R53-R65. [PMID: 27601016 DOI: 10.1530/eje-16-0373] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/17/2016] [Accepted: 09/05/2016] [Indexed: 12/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition in premenopausal women. The syndrome is characterized by hyperandrogenism, irregular menses and polycystic ovaries when other etiologies are excluded. Obesity, insulin resistance and low vitamin D levels are present in more than 50% patients with PCOS, these factors along with hyperandrogenism could have adverse effects on long-term health. Hyperinflammation and impaired epithelial function were reported to a larger extent in women with PCOS and could particularly be associated with hyperandrogenism, obesity and insulin resistance. Available data from register-based and data linkage studies support that metabolic-vascular and thyroid diseases, asthma, migraine, depression and cancer are diagnosed more frequently in PCOS, whereas fracture risk is decreased. Drug prescriptions are significantly more common in PCOS than controls within all diagnose categories including antibiotics. The causal relationship between PCOS and autoimmune disease represents an interesting new area of research. PCOS is a lifelong condition and long-term morbidity could be worsened by obesity, sedentary way of life, Western-style diet and smoking, whereas lifestyle intervention including weight loss may partly or fully resolve the symptoms of PCOS and could improve the long-term prognosis. In this review, the possible implications of increased morbidity for the clinical and biochemical evaluation of patients with PCOS at diagnosis and follow-up is further discussed along with possible modifying effects of medical treatment.
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Affiliation(s)
- Dorte Glintborg
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
| | - Marianne Andersen
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
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18
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Rezaee M, Asadi N, Pouralborz Y, Ghodrat M, Habibi S. A Review on Glycosylated Hemoglobin in Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2016; 29:562-566. [PMID: 27593259 DOI: 10.1016/j.jpag.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 12/17/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders among women of reproductive age, with a variety of complications and consequences mostly due to hyperandrogenism and insulin resistance (IR). PCOS patients with IR are at risk for metabolic syndrome and diabetes mellitus (DM) along with its complications such as cardiovascular events. There are several methods for screening IR in patients with PCOS to predict DM and other complications. Fasting plasma glucose test, oral glucose tolerance test, and insulin and glycosylated hemoglobin (HbA1c) levels are some available screening tools for IR. The American Diabetes Association recommended HbA1c to screen for DM because HbA1c is not affected by day-to-day plasma glucose levels and reflects the plasma glucose status during 2-3 months before measurement. Some studies have evaluated the role of HbA1c as a screening method to predict DM in PCOS patients, however, there are still controversies in this matter. Also some studies reported that HbA1c has a correlation with complications of PCOS such as metabolic syndrome and cardiovascular events. We found that HbA1c could be a suitable screening test for IR in PCOS patients but more studies are recommended, omitting confounding factors that could affect IR in patients with PCOS, such as antihyperglycemic agents like metformin, or lifestyle modification, which can be effective in reducing IR in patients with PCOS.
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Affiliation(s)
- Mohsen Rezaee
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yasna Pouralborz
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
| | - Mahshid Ghodrat
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Shaghayegh Habibi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
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Çelik E, Türkçüoğlu I, Ata B, Karaer A, Kırıcı P, Eraslan S, Taşkapan Ç, Berker B. Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome. J Turk Ger Gynecol Assoc 2016; 17:201-208. [PMID: 27990089 DOI: 10.5152/jtgga.2016.16133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/27/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To compare the prevalence of various metabolic and cardiovascular risk factors and insulin resistance between polycystic ovary syndrome (PCOS) patients with or without hyperandrogenism. MATERIAL AND METHODS This is a retrospective cross-sectional study involving women with PCOS as diagnosed according to the Androgen Excess (AE) Society definition (n=504) and women with normoandrogenemic PCOS (n=183). Anthropometrics, lipid profile, glucose, insulin, oral glucose tolerance test (OGTT), and reproductive hormone levels were evaluated. RESULTS Women with PCOS diagnosed according to the AE Society had a significantly higher prevalence of metabolic syndrome compared with the normoandrogenemic PCOS phenotype: odds ratio (OR) 2.95 [95% confidence interval (CI) 1.21-7.21]. There was no significant difference in the prevalence glucose intolerance test between the groups [OR: 2.15, 95% CI 0.71-6.56]. The prevalence of low high density lipoprotein (HDL)-cholesterol in the group under the AE-PCOS Society criteria was higher than that of the normoandrogenemic PCOS group [OR: 2.82, 95%CI 1.29-3.36]. CONCLUSION The risks of metabolic syndrome and cardiovascular disease may vary among the phenotypes of PCOS based on the Rotterdam criteria. This new data may be of reference in informing women with PCOS, although further prospective studies are needed to validate this proposition.
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Affiliation(s)
- Ebru Çelik
- Department of Obstetrics and Gynecology, İnönü University School of Medicine, Malatya, Turkey
| | - Ilgın Türkçüoğlu
- Department of Obstetrics and Gynecology, İnönü University School of Medicine, Malatya, Turkey
| | - Barış Ata
- Department of Obstetrics and Gynecology, Koç University School of Medicine, İstanbul, Turkey
| | - Abdullah Karaer
- Department of Obstetrics and Gynecology, İnönü University School of Medicine, Malatya, Turkey
| | - Pınar Kırıcı
- Department of Obstetrics and Gynecology, İnönü University School of Medicine, Malatya, Turkey
| | - Sevil Eraslan
- Department of Obstetrics and Gynecology, İnönü University School of Medicine, Malatya, Turkey
| | - Çağatay Taşkapan
- Department of Clinical Biochemistry, İnönü University School of Medicine, Malatya, Turkey
| | - Bülent Berker
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Ganie MA, Dhingra A, Nisar S, Sreenivas V, Shah ZA, Rashid A, Masoodi S, Gupta N. Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent. Fertil Steril 2016; 105:194-201.e1-3. [DOI: 10.1016/j.fertnstert.2015.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/29/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022]
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Mayer SB, Evans WS, Nestler JE. Polycystic ovary syndrome and insulin: our understanding in the past, present and future. ACTA ACUST UNITED AC 2015; 11:137-49. [PMID: 25776288 DOI: 10.2217/whe.14.73] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Insulin resistance is prevalent in women with polycystic ovary syndrome (PCOS), and plays a critical pathophysiologic role in both the metabolic and reproductive complications of PCOS. This review focuses on the contribution of insulin resistance to anovulation in PCOS and to the high risk for Type 2 diabetes, metabolic syndrome and early cardiovasular disease. Key points for clinicians emphasized by this review are the following: PCOS is a clinical diagnosis and alternative diagnoses must be excluded; PCOS carries an inherent risk of insulin resistance and, hence, metabolic consequences for which women with PCOS should be screened regardless of BMI or degree of obesity; and PCOS is associated with infertility and this should be discussed early on in care of women diagnosed with PCOS, recognizing that there are several possible strategies to address infertility in women with PCOS, each with its own risks and benefits.
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Affiliation(s)
- Stéphanie B Mayer
- Division of Endocrinology & Metabolism, Virginia Commonwealth University, Richmond, VA, USA
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Kelley CE, Brown AJ, Setji TL. Screening for glucose intolerance in polycystic ovary syndrome: hemoglobin A1C, fasting blood glucose or oral glucose tolerance test? Expert Rev Endocrinol Metab 2014; 9:671-683. [PMID: 30736203 DOI: 10.1586/17446651.2014.941814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a chronic condition with many reproductive, metabolic and psychological manifestations. Insulin resistance puts women with PCOS at an increased risk for developing impaired glucose tolerance (IGT) and diabetes (T2D). An oral glucose tolerance test is the preferred IGT/T2D screening test, since it is most sensitive for detecting early glucose abnormalities. The goals in detecting IGT in these women are to avoid progression to T2D, modify cardiovascular risk and prevent gestational diabetes. Periodic IGT/T2D rescreening is necessary, given their propensity for more rapid deterioration in glucose tolerance. Lifestyle intervention is first-line therapy for PCOS women with IGT. Metformin is an option if lifestyle intervention fails to have an impact, while bariatric surgery is reserved for a select set of morbidly obese patients.
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Affiliation(s)
- Carly E Kelley
- a Department of Medicine, Division of Endocrinology, Duke University Medical Center, DUMC 3924, 201 Trent Drive, Durham, NC 27710, USA
| | - Ann J Brown
- b Department of Medicine, Division of Endocrinology, Duke University Medical Center, DUMC 3611, 201 Trent Drive, Durham, NC 27710, USA
| | - Tracy L Setji
- c Department of Medicine, Division of Endocrinology, Duke University Medical Center, DUMC 3222, 201 Trent Drive, Durham, NC 27710, USA
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Wu S, Shi Y, Pan Y, Li J, Jia Q, Zhang N, Zhao X, Liu G, Wang Y, Wang Y, Wang C. Glycated hemoglobin independently or in combination with fasting plasma glucose versus oral glucose tolerance test to detect abnormal glycometabolism in acute ischemic stroke: a Chinese cross-sectional study. BMC Neurol 2014; 14:177. [PMID: 25209629 PMCID: PMC4172972 DOI: 10.1186/s12883-014-0177-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 09/03/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The investigation of glycated hemoglobin (HbA1c) as a diagnostic tool for abnormal glycometabolism is lack in acute ischemic stroke patients in China and worldwide. This paper was aimed to determine whether HbA1c, fasting plasma glucose (FPG), or HbA1c combined with FPG, could be used to screen for diabetes mellitus (DM) or prediabetes in acute ischemic stroke patients without previous DM. METHODS Acute ischemic stroke patients without previous DM (n = 1,316) were selected from the Abnormal gluCose Regulation in Patients with Acute StrOke acrosS China Study (ACROSS-China). Oral glucose tolerance test (OGTT), HbA1c, FPG, and HbA1c combined with FPG were used as the screening methods to categorize the glycometabolic status. OGTT was taken as the golden method. Venn diagrams and the overlap index were used to determine the associations among the three methods of identifying abnormal glycometabolism. The area under the receiver operating characteristic curve (AUROC) and Youden index were used to assess and compare the accuracy in detecting abnormal glycometabolism. Youden analyses were performed to determine the ideal cutoff values of HbA1c in diagnosing abnormal glycometabolism. RESULTS In acute ischemic stroke patients without previous DM, the overlaps of HbA1c versus OGTT, HbA1c versus FPG, and all the three methods independently, were low for detecting abnormal glycometabolism (all <50%). HbA1c can significantly detect more cases of prediabetes than OGTT (P < 0.001). The combination of HbA1c and FPG significantly raised the sensitivity to over 60.0%, specificity to over 80.0%, and the diagnostic accuracy (Youden index from under 40.0% to 42.4%)for DM. HbA1c of 5.7%-6.4% had a low to moderate concordance with OGTT for identifying prediabetes (AUROC = 0.557, P = 0.001). HbA1c values of 6.3% and 5.9% were found to be the ideal cutoff values for detecting DM and abnormal glycometabolism in our data, respectively. CONCLUSIONS The combination of HbA1c and FPG increased the diagnostic rate of DM when compared with OGTT, and increased the diagnostic accuracy for DM compared with HbA1c or FPG alone. Our results advocate the use of HbA1c as screening tool for the diagnosis of pre-diabetes.
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Guzel EC, Celik C, Abali R, Kucukyalcin V, Celik E, Guzel M, Yilmaz M. Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome. Gynecol Endocrinol 2014; 30:419-22. [PMID: 24524360 DOI: 10.3109/09513590.2014.888412] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We aimed to investigate whether overweight/obesity is associated with omentin and chemerin. The study group consisted of 81 women with Polycystic ovarian syndrome (PCOS) (41 lean, BMI < 25 kg/m² and 40 overweight or obese, BMI > 25 kg/m²) and 61 healthy subjects (31 lean, BMI < 25 kg/m² and 30 overweight or obese, BMI > 25 kg/m²; control group). The clinical, endocrine, metabolic parameters, plasma omentin and chemerin levels were measured in patients and compared to control. In all subjects with PCOS (n = 80), serum chemerin levels were higher compared with those of the controls (n = 58) (7.71 ± 1.78 ng/mL versus 6.94 ± 0.82 ng/mL, p = 0.003). However, serum omentin levels were not significantly different between the PCOS subjects and the controls (1.55 ± 0.43 ng/mL versus 1.69 ± 0.37 ng/mL, p = 0.056). The mean chemerin concentrations were significantly elevated in the obese PCOS group compared with the obese control subjects (8.98 ± 1.45 ng/mL versus 7.02 ± 0.67 ng/mL, p = 0.000) and the nonobese PCOS group compared with the obese control subjects (6.57 ± 1.17 ng/mL versus 7.02 ± 0.67 ng/mL, p = 0.000). In conclusion, fat mass seems to be the main determinant factor of increased chemerin and decreased omentin in women with PCOS.
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de Medeiros SF, Yamamoto MMW, Bueno HB, Belizario D, Barbosa JS. Prevalence of elevated glycated hemoglobin concentrations in the polycystic ovary syndrome: anthropometrical and metabolic relationship in amazonian women. J Clin Med Res 2014; 6:278-86. [PMID: 24883154 PMCID: PMC4039100 DOI: 10.14740/jocmr1829w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To determine the prevalence of elevated glycated hemoglobin (HbA1c) and to examine its relationship with other carbohydrate metabolic parameter among Brazilian women with polycystic ovary syndrome (PCOS). METHODS A cross-sectional study including 288 PCOS patients was conducted. Anthropometrical, clinical, biochemical and endocrine parameters were evaluated. RESULTS The mean age was 26.92 ± 5.51 years. HbA1c mean concentration was 5.83±1.34%. In 38.54% of patients, HbA1c was ≥ 5.7%. HbA1c was positively correlated with body weight (r = 0.142, P = 0.017), body mass index (P = 0.000), waist:hip ratio (P = 0.000), fat mass (P = 0.000), conicity index (P = 0.000), triglyceride (P = 0.001), C-peptide (P = 0.000), total testosterone (P = 0.003), free testosterone (P = 0.000), free androgen index (P = 0.006) and fasting insulin (P = 0.025). Using the oral glucose tolerance test, HbA1c showed positive correlation with glucose concentrations at any point in time (P < 0.05). CONCLUSIONS HbA1c was elevated in nearly 40% of PCOS patients and it showed positive correlation with several anthropometric and metabolic factors and androgen levels. The current study provides further evidence that HbA1C is higher in PCOS patients and may have a potential role in the prediction of dysglycemic disease in these women.
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Affiliation(s)
- Sebastiao Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, 78055-728 Cuiaba, MT, Brazil ; Tropical Institute of Reproductive Medicine and Menopause, 78043-306 Cuiaba, MT, Brazil
| | - Marcia Marly Winck Yamamoto
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, 78055-728 Cuiaba, MT, Brazil ; Tropical Institute of Reproductive Medicine and Menopause, 78043-306 Cuiaba, MT, Brazil
| | - Herica Bernardes Bueno
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, 78055-728 Cuiaba, MT, Brazil
| | - Danilla Belizario
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, 78055-728 Cuiaba, MT, Brazil
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Celik C, Tasdemir N, Abali R, Bastu E, Yilmaz M. Progression to impaired glucose tolerance or type 2 diabetes mellitus in polycystic ovary syndrome: a controlled follow-up study. Fertil Steril 2014; 101:1123-8.e1. [PMID: 24502891 DOI: 10.1016/j.fertnstert.2013.12.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether retesting with the oral glucose tolerance test (OGTT) is useful and necessary for all women with polycystic ovary syndrome (PCOS). DESIGN Follow-up study. SETTING Tertiary medical center. PATIENT(S) Eighty-four women with PCOS and 45 healthy controls. INTERVENTION(S) Peripheral venous blood sampling. MAIN OUTCOME MEASURE(S) We performed a 75-g 2-hour OGTT in women with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) at the time of the first test with and without PCOS. RESULT(S) The average follow-up period for women with PCOS was 2.6 years (range, 2-4.17 years). Seventy-eight of these women had NGT at baseline, 11.5% converted to IGT, with an annualized incidence rate of 4.5%. Of those women with IGT at baseline (n = 6), 33.3% converted to type 2 diabetes mellitus, with an annualized incidence rate of 10.4%. In the healthy subjects, the average follow-up period was 2.6 years (range, 2-4.08 years). Forty-two of these women had NGT at baseline, 2.3% converted to IGT, giving a progression of 0.9% per year. Among the three women with IGT at baseline, 33.3% reverted to NGT, and 66.6% had persistent IGT. CONCLUSION(S) Conversion rates from NGT to IGT or type 2 diabetes mellitus were accelerated in women with PCOS compared with healthy subjects. Women with PCOS should be tested regularly for early detection of abnormal glucose tolerance. In addition, the interval for periodic rescreening should be determined by further studies involving more women with PCOS.
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Affiliation(s)
- Cem Celik
- Department of Gynecology and Obstetrics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
| | - Nicel Tasdemir
- Department of Gynecology and Obstetrics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Remzi Abali
- Department of Gynecology and Obstetrics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Ercan Bastu
- Department of Gynecology and Obstetrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
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Dalamaga M, Papadavid E, Basios G, Vaggopoulos V, Rigopoulos D, Kassanos D, Trakakis E. Ovarian SAHA syndrome is associated with a more insulin-resistant profile and represents an independent risk factor for glucose abnormalities in women with polycystic ovary syndrome: A prospective controlled study. J Am Acad Dermatol 2013; 69:922-30. [DOI: 10.1016/j.jaad.2013.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/05/2013] [Accepted: 09/08/2013] [Indexed: 01/21/2023]
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Mani H, Khunti K, Levy M, Davies MJ. Diabetes advice for women with polycystic ovary syndrome: prevention, prevention, prevention. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.13.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The polycystic ovary syndrome (PCOS), the most common hyperandrogenic disorder affecting 4-7% of women, is often associated with metabolic alterations, chiefly insulin resistance and obesity. Based on available scientific evidence, PCOS should be regarded as an independent risk for the development of glucose intolerance states. This short review summarizes the available literature on the prevalence and incidence of impaired glucose tolerance and Type 2 diabetes in this disorder. In addition, some insights on potential factors responsible for individual susceptibility are discussed. Targeted intervention studies focused on prevention and treatment of glucose intolerance states in PCOS are warranted.
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Affiliation(s)
- R Pasquali
- Division of Endocrinology, Department of Medical and Surgical Sciences (DIMEC), S. Orsola-Malpighi Hospital, University Alma Mater Studiorum, Via Massarenti 9, Bologna, Italy.
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Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Assessment of glucose metabolism in polycystic ovary syndrome: HbA1c or fasting glucose compared with the oral glucose tolerance test as a screening method. Hum Reprod 2013; 28:2537-44. [PMID: 23756702 DOI: 10.1093/humrep/det255] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY QUESTION Are HbA1c and fasting glucose (FG) useful in predicting the presence of prediabetes and type 2 diabetes (T2DM) in a large cohort of women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER HbA1c and FG are not suitable as screening tools for prediabetes in a large cohort of PCOS women but do show a good level of agreement with T2DM. WHAT IS KNOWN ALREADY Women with PCOS have an increased risk of prediabetes and T2DM. As performing an oral glucose tolerance test (OGTT) is time consuming, HbA1c and FG have been suggested as screening tools for prediabetes and T2DM. STUDY DESIGN, SIZE, DURATION This was a cross-sectional study of 671 women with PCOS conducted from 2006 to 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was carried out at the endocrinological outpatient department of the Medical University of Graz, Austria. We performed 75 g 2-h OGTTs and measured HbA1c in 671 women with PCOS aged 16-45 years with a median BMI of 24.2 (21.3-30.1) kg/m². PCOS was defined according to the Rotterdam criteria. Prediabetes (FG 100-125 mg/dl and/or 2-h glucose 140-199 mg/dl and/or HbA1c 5.7-6.4%) and T2DM (FG ≥ 126 mg/dl and/or 2-h glucose ≥200 mg/dl and/or HbA1c ≥ 6.5%) were diagnosed according to the American Diabetes Association (ADA) criteria. Levels of agreement between different definitions were analyzed using κ-index. MAIN RESULTS AND THE ROLE OF CHANCE According to the ADA criteria, we found prediabetes and T2DM in 12.8% (n = 76) and 1.5% (n = 9) of PCOS women, respectively. When using elevated HbA1c (5.7-6.4%) for defining prediabetes, 19 (3.2%) of all PCOS women had prediabetes with a κ-index of 0.36. When using elevated FG (100-125 mg/dl) for defining prediabetes, 31 (5.2%) of all the PCOS women were diagnosed with prediabetes with a κ-index of 0.05. Further, elevated HbA1c (≥6.5% defining T2DM) was found in six (0.9%) PCOS women (κ-index 0.80), and elevated FG (≥126 mg/dl diagnosing T2DM) was found in seven PCOS women (1%; κ-index 0.82). LIMITATIONS, REASONS FOR CAUTION Our results are limited to an Austrian cohort of PCOS women diagnosed by Rotterdam criteria with a median BMI in the normal weight range. WIDER IMPLICATIONS OF THE FINDINGS Our results are in line with results from previous smaller PCOS cohorts. Our findings do not support the recommendation that FG or HbA1c can be used for the screening of prediabetes in women with PCOS. For such women, OGTT should be performed for screening of prediabetes. Whether this finding is generalizable to other cohorts remains to be determined in further studies.
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Affiliation(s)
- E Lerchbaum
- Department of Internal Medicine, Medical University of Graz, Graz, Austria.
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