Can dysglycemia in OGTT be predicted by baseline parameters in patients with PCOS?

Abstract

Background: Polycystic ovary syndrome (PCOS) is considered a risk factor for 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 WHO 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; and 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.

The role of glycated hemoglobin in the diagnosis of prediabetes and diabetes mellitus in young women with polycystic ovary syndrome

“…Hence, the evaluation of glycemic status using OGTT in all women with PCOS is strongly supported. 3 We agree that OGTT is the gold standard and that it should be used whenever possible, but according to our results, the use of HbA1c as an initial screening method for glucose metabolism disorders in young women with PCOS could be employed in places where GTT is not available. A cohort study 18 compared women with PCOS and age-matched women without PCOS to examine the prevalence and risk factors for changes in HbA1c.…”

“…Polycystic ovary syndrome (PCOS) is a metabolic disorder that is associated with an increased risk of prediabetes and type 2 diabetes mellitus (T2DM). [1][2][3] These conditions are diagnosed at a younger age when compared to women without PCOS. 4 Furthermore, the prevalence of dysglycemia is generally higher in women with PCOS compared to women without PCOS of the same age and body weight.…”

“…[8][9][10][11] Although considered the gold standard for the diagnosis of prediabetes and T2DM, the OGTT is rarely used for diagnostic purposes in non-pregnant women, except those with PCOS. 3,9 Admittedly, the OGTT is a more expensive and complex test that requires longer fasting and is more time consuming, factors that are often unpleasant for women. 2 In 2010, the American Diabetes Association (ADA) included the measurement of HbA1c as a tool for the screening, diagnosis, and follow-up of glucose metabolism abnormalities.…”

“…13 The 2023 International Evidence-based Guideline for the Assessment and Management of PCOS consensus has reported that whilst the quality of evidence is low, the findings are consistent and support a weak recommendation for OGTT as the preferred tool for diagnosis of T2DM in women with PCOS. 6 Although OGTT is recognized as the gold standard, 3,6 the role of HbA1c assessment has not been clearly established nor is it known whether this method could be used for initial screening in women with PCOS, if an OGTT cannot be performed. 6 There are controversies among studies that evaluated the role of HbA1c as a screening method for prediabetes and DM in women with PCOS.…”

“…Polycystic ovary syndrome (PCOS) is a metabolic disorder that is associated with an increased risk of prediabetes and type 2 diabetes mellitus (T2DM) 1–3 . These conditions are diagnosed at a younger age when compared to women without PCOS 4 .…”