High Prevalence of the Polycystic Ovary Syndrome and Hirsutism in Women with Type 1 Diabetes Mellitus1

Abstract

The current recommendation for strict metabolic control of type 1 diabetes mellitus requires the administration of supraphysiological doses of insulin, which might result in insulin-mediated stimulation of androgen synthesis, as occurs in insulin-resistant states. At present, the prevalence of hyperandrogenic disorders in women with type 1 diabetes mellitus is unknown.Eighty-five women with type 1 diabetes mellitus were evaluated for symptoms and signs of hyperandrogenism. In 68 of the patients, several serum androgen and hormone concentrations were measured. The polycystic ovary syndrome (PCOS) was defined by the presence of menstrual dysfunction, together with clinical and/or biochemical evidence of hyperandrogenism, and exclusion of other etiologies. Eighteen healthy women, menstruating regularly, served as controls for the androgenic profiles.Thirty-three patients (38.8%) presented hyperandrogenic disorders (16 had PCOS, and 17 had hirsutism without menstrual dysfunction). Type 1 diabetic patients with PCOS presented increased serum total and free testosterone concentrations, and serum androstenedione levels, but had normal serum sex hormone-binding globulin and dehydroepiandrosterone-sulfate levels. Hirsute type 1 diabetic women without menstrual dysfunction presented normal serum androgen levels. There were no significant differences between hyperandrogenic and nonhyperandrogenic type 1 diabetes mellitus women in clinical variables such as the duration of diabetes, age at diagnosis of diabetes, conventional or intensive insulin therapy, mean daily insulin dosage, or metabolic control.In conclusion, women with type 1 diabetes mellitus have a high prevalence of hyperandrogenic disorders, including PCOS and hirsutism. (J Clin Endocrinol Metab 85: 4182-4187, 2000)

High Prevalence of Polycystic Ovary Syndrome in Type 1 Diabetes Mellitus Adolescents: Is There a Difference Depending on the NIH and Rotterdam Criteria?

“…However, in other studies, no difference was found in the mean daily insulin doses, diabetes duration, or the degree of metabolic control when comparing T1DM adolescent girls and women affected by hyperandrogenism to controls [3-5, 28, 42]. Our findings, in accordance with these results, could be explained by the small size of our population.…”

“…When we used the new ovarian volume of 12 mL that was published after the design of our study [11], we found no significant differences in the PCOS prevalence (41.7% for a cutoff of 12 mL vs. 47.9% for a cutoff of 10 mL, p = 0.68). This higher prevalence of PCOS has also been described in adult women when they are affected by T1DM compared to the general population [3, 4, 28]. The prevalence of PCOM is high in healthy adolescents (30–40%) [29] and in women with T1DM (33%, 95% CI 24–44) [6].…”

“…Our prospective cohort of 78 girls aged 12–18 years and affected by T1DM has been described in a previous work [3]. Of this cohort, we selected all patients with a gynecological age of 2 years or more ( n = 53) [17, 18].…”

“…Type 1 diabetes mellitus (T1DM) is associated with a high prevalence of clinical or biological hyperandrogenism in adolescent girls and adult women [3, 4], and we described a high prevalence of either hirsutism (20.5%) or menstrual disorders (44%) in adolescent girls with T1DM [5]. In adult women affected by T1DM, the global prevalence of PCOS is 24% (95% CI 15–34) [6] but changes according to the criteria used for the definition of PCOS: according to NIH criteria, the prevalence is 12% [4] to 19% [3]; according to Rotterdam criteria, it is 40% [4], and according to Androgen Excess Society criteria, it is 31% [4]. In adolescent girls, the prevalence of PCOS is estimated to be 0.81–6.2% according to different countries’ data [7-11].…”

Growth and Body Composition in Type 1 Diabetes mellitus

“…The implications of hyperinsulinaemia in the girls with T1DM are not just limited to weight gain as it is also associated with ovarian hyperandrogenism and polycystic ovarian changes [47, 48]. The consequent hyperandrogenaemia in these girls may be linked to their increased risk of cardiovascular disease and microvascular complications.…”