Glucose Intolerance in a Large Cohort of Mediterranean Women With Polycystic Ovary Syndrome

Abstract

The aim of this study was to investigate the phenotypic parameters and associated factors characterizing the development of glucose intolerance in polycystic ovary syndrome (PCOS). Among the 121 PCOS female subjects from the Mediterranean region, 15.7 and 2.5% displayed impaired glucose tolerance and type 2 diabetes, respectively. These subjects were included in a single group of overweight or obese subjects presenting with glucose intolerance (GI) states. PCOS women with normal glucose tolerance (81.8%) were subdivided into two groups: those who were overweight or obese and those of normal weight. Metabolic and hormonal characteristics of the GI group included significantly higher fasting and glucose-stimulated insulin levels, more severe insulin resistance, hyperandrogenemia, and significantly higher cortisol and androstenedione responses to 1-24 ACTH stimulation. One important finding was that lower birth weight and earlier age of menarche were associated with GI in PCOS women. Frequency of hirsutism, oligomenorrhea, acne, and acanthosis nigricans did not characterize women with GI. Our findings indicate that PCOS patients with GI represent a subgroup with specific clinical and hormonal characteristics. Our observations may have an important impact in preventative and therapeutic strategies. Diabetes 53: 2353-2358, 2004 P olycystic ovary syndrome (PCOS) affects 5-10% of women during their reproductive age (1,2) and is one of the most common causes of female infertility (1). The major clinical manifestations of the syndrome in adults are chronic anovulation, menstrual abnormalities, and hyperandrogenism (1). Most PCOS women present with insulin resistance and hyperinsulinemia (1), which play an important role in the pathogenesis of PCOS by modulating both ovarian and adrenal androgen production and decreasing sex hormoneϪbinding globulin (SHBG) liver synthesis and blood levels (3).Studies in American and Asian subjects have shown that, compared with the general population, women with PCOS have an increased risk for impaired glucose tolerance (IGT) and type 2 diabetes (4 -6), with a tendency toward early development of glucose intolerance (GI) states (7). However, to our knowledge, no studies have been performed on subjects from the Mediterranean region. The strong connection between PCOS and GI states is further emphasized by the high prevalence of polycystic ovarian morphology found on ultrasound scans in premenopausal women with type 2 diabetes (8) and those with previous gestational diabetes (9).As has been seen in the general population (10), there is evidence that insulin resistance may play a major pathophysiological role in the development of GI in PCOS women (11,12). The decreased insulin sensitivity in PCOS women appears in fact quite similar to that found in type 2 diabetic patients and to be relatively independent of obesity, fat distribution, and lean body mass (13). On the other hand, there is strong evidence that obesity per se, particularly the abdominal phenotype, represents an important indepe...

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

“…In our cohort of 118 consecutive PCOS women with a mean age of approximately 29 years, 21% were diagnosed with either IGT or type 2 diabetes, according to the 2-h glucose concentration of an OGTT. This prevalence is similar to results reported for other PCOS cohorts of comparable age [15,16,41], and is significantly higher than the IGM prevalence in the general population [42]. Hence, screening of PCOS women for IGM has been recommended [13,17,19].…”

“…Women with PCOS often suffer from obesity, insulin resistance, IGT, or type 2 diabetes [14][15][16][17]41]. In our cohort of 118 consecutive PCOS women with a mean age of approximately 29 years, 21% were diagnosed with either IGT or type 2 diabetes, according to the 2-h glucose concentration of an OGTT.…”

“…Furthermore, insulin resistance is proposed to be a major risk factor for the development of type 2 diabetes mellitus and subsequent cardiovascular disease [10][11][12][13]. Estimates from several studies indicate that approximately 20-40% of adult and adolescent PCOS women, including both lean and obese patients, suffer from impaired glucose metabolism (IGM, defined as impaired glucose tolerance or type 2 diabetes) [14][15][16][17].…”

Association between age at menarche and risk of diabetes in adults: results from the EPIC-Norfolk cohort study

“…The Rancho Bernardo Study [11] studied 997 women aged 50 to 92 years and reported that earlier menarche was associated with higher fasting and post-challenge plasma glucose levels. In a study of 121 women with polycystic ovary syndrome, Gambineri et al [13] reported that earlier menarche onset was associated with impaired glucose tolerance. However, Cooper et al [12] found no association between age at Age at menarche (years)…”

“…Previous studies have reported associations between earlier age at menarche and higher blood glucose levels in adults, but they may have been underpowered to detect any association with diabetes risk [11][12][13]. We hypothesised that earlier age at menarche would also predict subsequent diabetes risk.…”