Using simple clinical measures to predict insulin resistance or hyperglycemia in girls with polycystic ovarian syndrome

Abstract

Background: Polycystic ovarian syndrome (PCOS) includes insulin resistance (IR) and impaired glucose tolerance (IGT) in youth, and a greatly elevated risk of type 2 diabetes in adulthood. Identifying IR is challenging and documenting IGT requires an oral glucose tolerance test (OGTT). Objective: Identify an easily applied surrogate measures for IR and IGT in girls with PCOS. Methods: We studied 28 girls with PCOS [BMI percentile 98 (83,99); 15.5 (14.5,16.6) years of age] and 20 with normal menses [BMI percentile (97 (88,99); 15.5 (13.3,16.1) years]. Hyperinsulinemic-euglycemic clamps (insulin dose of 80 μU/ml/min) to determine glucose infusion rate (GIR) and a 75 gram OGTT were performed. Surrogates for IR including fasting insulin, HOMA-IR, Matsuda index and eIS were compared to IGT status and GIR. Spearman correlations were performed between surrogates and GIR or IGT, and receiver operator curve (ROC) analysis to predict GIR below the median or IGT status. Results: GIR was lower in PCOS (12.9±4.6 vs. 17.1±5.1 mg/kg fat free mass·min; p=0.01). Within PCOS, HOMA-IR (r=−0.78, p<0.0001), e-IS (r=0.70, p<0.001), and Matsuda (r=0.533, p<0.001) correlated with GIR. e-IS provided a good sensitivity (100%) and specificity (71%) to identify IR (e-IS cutoff: <6.3, ROC-area under curve=0.898). Fasting insulin >22 IU/ml had the best sensitivity (88%), specificity (78%) and ROC (0.760) for IGT status. Conclusions: Girls with PCOS have significant IR, and IGT is common. Both eIS and fasting insulin are obtainable without an OGTT or clamp and could be used clinically to guide treatment in PCOS.

Development of type 2 diabetes in adolescent girls with polycystic ovary syndrome and obesity

“…The prevalence of impaired glucose tolerance (IGT) was 25% in a Chinese study of 20 overweight or obese girls with PCOS and 24% in a larger Canadian study of 117 girls of similar weight 16,17 . In a mixed BMI cohort of 28 girls with PCOS of similar racial/ethnic composition as our study, 32% had IGT 27 . These rates of dysglycemia are nearly twice that reported for adolescent girls 13.4% (10.8–16.5) included in a recent NHANES study 28 .…”

“…16,17 In a mixed BMI cohort of 28 girls with PCOS of similar racial/ethnic composition as our study, 32% had IGT. 27 These rates of dysglycemia are nearly twice that reported for adolescent girls 13.4% (10.8-16.5) included in a recent NHANES study. 28 Our rates of pre-diabetes showed that early evidence of dysglycemia was common at 24%, similar to other adolescent PCOS cohorts and is related to T2D development.…”

Anti-Mullerian hormone and associated pregnancy outcomes in females with polycystic ovary syndrome undergoing In vitro fertilization-embryo transfer

“…Therefore, PCOS patients are prone to have diabetes during pregnancy. 22,23 According to another study, high androgen levels in PCOS patients cause increased secretion of vascular smooth muscle cells, resulting in narrowing of the vascular lumen, increased blood flow resistance, poor vascular endothelial function, and eventually the development of pregnancy-induced hypertension. 24 In this study, compared with patients in group B, the incidence of gestational diabetes and hypertension in pregnancy in group A was significantly lower, which may be due to the low serum AMH level.…”

Oral minimal model-based estimates of insulin sensitivity in obese youth depend on oral glucose tolerance test protocol duration

“…Similarly, the intravenous glucose tolerance test (IVGTT) is non-physiological due to the IV infusion that bypasses the gut [ 21 ]. Several surrogate indices, including HOMA [ 22 ], QUICKI [ 23 ], and the Matsuda index [ 24 ] have been developed to efficiently quantify in the clinical setting [ 23 , [25] , [26] , [27] , [28] , [29] ]. Alternatively, the Oral Minimal Model (OMM), a mathematical model of glucose-insulin dynamics in the more physiological conditions of an oral glucose tolerance test (OGTT) [ [30] , [31] , [32] ], may be used to estimate .…”