Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis

Abstract

A few small studies have reported increased prevalences of polycystic ovary syndrome (PCOS) and symptoms of androgen excess in women with type 1 diabetes. PURPOSEWe performed a systematic review and meta-analysis of studies evaluating androgen excess symptoms and PCOS in women with type 1 diabetes. DATA SOURCESThe Entrez-PubMed and Scopus electronic databases were used. STUDY SELECTIONWe selected studies addressing androgen excess signs, symptoms, and disorders in girls, adolescents, and adult women with type 1 diabetes. DATA EXTRACTIONThe main outcome measures were prevalences of PCOS, hyperandrogenemia, hirsutism, menstrual dysfunction, and polycystic ovarian morphology (PCOM). DATA SYNTHESISNine primary studies involving 475 adolescent or adult women with type 1 diabetes were included. The prevalences of PCOS and associated traits in women with type 1 diabetes were 24% (95% CI 15-34) for PCOS, 25% (95% CI 17-33) for hyperandrogenemia, 25% (95% CI 16-36) for hirsutism, 24% (95% CI 17-32) for menstrual dysfunction, and 33% (95% CI 24-44) for PCOM. These figures are considerably higher than those reported earlier in the general population without diabetes. LIMITATIONSThe data collected in the original studies were heterogeneous in age, race, ethnicity, and criteria used for the diagnosis of PCOS; yet, we used a quality-effects model in the meta-analyses to overcome this limitation. CONCLUSIONSPCOS and its related traits are frequent findings in women with type 1 diabetes. PCOS may contribute to the subfertility of these women by a mechanism that does not directly depend on glycemic/metabolic control among other negative consequences for their health. Hence, screening for PCOS and androgen excess should be included in current guidelines for the management of type 1 diabetes in women.

Does polycystic ovary syndrome increase the risk of subclinical vascular disease in normal-weight type 1 diabetic women?

“…In a recent meta -analysis, Escobar -Morreale et al 18 reported that the development of full PCOS phenotype with its symptoms in girls with T1DM is probably a long -term process. Thus, cardiometabolic consequences are observed later in life, and prospective studies are required to further investigate this issue.…”

“…17 It has been reported that the prevalence of PCOS in adult women with T1DM is significantly higher than in controls and reaches 40%, according to the Rotterdam diagnostic criteria. 18 Despite limited evidence, PCOS appears to be among the most common endocrine disorders in women of reproductive age with T1DM. 18 Patients with T1DM also have an increased risk of endothelial dysfunction, premature atherosclerosis, and CV diseases.…”

“…18 Despite limited evidence, PCOS appears to be among the most common endocrine disorders in women of reproductive age with T1DM. 18 Patients with T1DM also have an increased risk of endothelial dysfunction, premature atherosclerosis, and CV diseases. 19,20 CIMT and parameters of arterial stiffness in this group of patients are significantly higher in comparison with controls, especially when diabetic complications are present.…”

Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes

“…Since a high percentage (over 70%) of women with type 1 diabetes suffer from menstrual cycle disorders, hyperandrogenism and polycystic ovary syndrome (PCOS), it is recommended to carefully assess and possibly correct gestational age with the use of ultrasound examination during the first trimester and to compare the result with the date of last menstrual period [43].…”

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

“…It seems appropriate to mention that girls who have type-1 DM can also have hyperandrogenism (peculiar trait of PCOS) caused by an excessive administration of exogenous insulin, resulting in a hyperstimulation of theca cells in ovary, which produce sexual hormones [3].…”