Polycystic Ovary Syndrome Is a Risk Factor for Type 2 Diabetes

Abstract

Polycystic ovary syndrome (PCOS) recently has been identified as a risk factor associated with type 2 diabetes. However, the evidence derives from cross-sectional observational studies, retrospective studies, or short-term prospective studies. This long-term prospective study of a large cohort of women with PCOS, followed from youth to middle age, aimed at estimating, for the first time, the incidence and potential predictors of type 2 diabetes in this population. A total of 255 women with PCOS were followed for at least 10 years (mean follow-up 16.9 years). Six women were patients with diabetes at baseline, and another 42 women developed type 2 diabetes during the follow-up. The incidence rate of type 2 diabetes in the study population was 1.05 per 100 person-years. The age-standardized prevalence of diabetes at the end of follow-up was 39.3%, which is significantly higher with respect to that of the general Italian female population of a similar age (5.8%). The likelihood of developing type 2 diabetes significantly increased as BMI, fasting glucose, and glucose area under the curve at baseline increased and significantly decreased as sex hormone–binding globulin (SHBG) levels at follow-up increased. This study demonstrates that the risk of type 2 diabetes is markedly elevated in middle-aged women with PCOS and suggests including BMI, glucose, and SHBG-circulating levels in the risk stratification.

Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome

“…Many different medical conditions have been associated with the diagnosis of PCOS (32). The risk of type 2 diabetes is currently estimated to be five to ten times increased in PCOS, whereas the risk of cardiovascular disease is debated (3,9,13,33,34). The risk of cardiometabolic disease may be highly influenced by BMI, ethnicity, and the presence of different Rotterdam criteria, especially hyperandrogenism (5, 35), whereas high SHBG was a protective factor (34).…”

“…The risk of type 2 diabetes is currently estimated to be five to ten times increased in PCOS, whereas the risk of cardiovascular disease is debated (3,9,13,33,34). The risk of cardiometabolic disease may be highly influenced by BMI, ethnicity, and the presence of different Rotterdam criteria, especially hyperandrogenism (5, 35), whereas high SHBG was a protective factor (34). In our cohort, 1.5% patients were diagnosed with type 2 diabetes compared with 0.4% controls, which confirmed a five times increased risk of type 2 diabetes in PCOS.…”

Tissue-specific dysregulation of 11β-hydroxysteroid dehydrogenase type 1 in overweight/obese women with polycystic ovary syndrome compared with weight-matched controls

“…Obesity and insulin resistance are also frequently present and contribute to the pathogenesis of PCOS (12). In addition, women with PCOS frequently develop metabolic dysregulations at early ages, particularly type 2 diabetes (13). One hypothesis to explain the association of obesity with PCOS is that altered cortisol metabolism contributes to the activation of the hypothalamic-pituitary-adrenal axis and induces ACTH-dependent androgen excess.…”

PCOS and diabetes mellitus: from insulin resistance to altered beta pancreatic function, a link in evolution

“…Age-standardized DM2 prevalence resulted 39.3% at the end of the follow-up, significantly higher than the prevalence found in the same-age female population [2].…”