Korean J Obstet Gynecol.  2012 Jul;55(7):477-484. 10.5468/KJOG.2012.55.7.477.

Predictors of abnormal glucose tolerance among women with polycystic ovary syndrome

• Koh AR
• Lee SJ
• Park SY
• Kim MK
• Kim JY
• Lee KW
• Kim KH

• KMID: 1992557
• DOI: http://doi.org/10.5468/KJOG.2012.55.7.477

Abstract

OBJECTIVE
To determine the parameters associated with the risk for abnormal glucose tolerance (AGT) among women with polycystic ovary syndrome (PCOS) and to assess the optimal screening tests to predict AGT within this population.
METHODS
We evaluated 85 women with PCOS and 53 control women. All participants had an oral glucose tolerance test (OGTT) and hormonal blood profiles, including the measurement of follicle stimulating hormone, leutinizing hormone, estradiol testosterone, and serum lipid profiles.
RESULTS
Among the women with PCOS, those with AGT had significantly higher homeostasis model assessment of insulin resistance (P<0.001) values than those with normal glucose tolerance. The prevalence of impaired glucose tolerance (IGT) and/or impaired fasting glucose was 48.2% (41/85) in women with PCOS; 16 of 41 subjects with AGT were IGT. Six of 16 subjects (37.5%) with IGT had normal fasting plasma glucose (FPG<100 mg/dL). Thus, the FPG failed to detect 37.5% of women with PCOS who were found to have AGT with the OGTT. Multivariate logistic regression analysis revealed that insulin, body mass index (BMI), age, and triglyceride (TG) were significant risk factors for abnormal glucose metabolism.
CONCLUSION
Insulin, BMI, age, and TG predicted abnormal glucose metabolism in women with PCOS. The OGTT was a more reliable predictor of AGT than fasting plasma glucose. We recommend that women with PCOS undergo periodic screening for AGT using the OGTT, particularly if they have any of the above risk factors.

Keyword

Polycystic ovarian syndrome; Oral glucose tolerance test; Prevalence; Risk factors

MeSH Terms

Body Mass Index
Estradiol
Fasting
Female
Follicle Stimulating Hormone
Glucose
Glucose Tolerance Test
Homeostasis
Humans
Insulin
Insulin Resistance
Logistic Models
Mass Screening
Plasma
Polycystic Ovary Syndrome
Prevalence
Risk Factors
Testosterone
Estradiol
Follicle Stimulating Hormone
Glucose
Insulin
Testosterone

Reference

1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004. 89:2745–2749.

2. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999. 22:141–146.

3. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999. 84:165–169.

4. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome: a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007. 92:4546–4556.

5. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004. 19:41–47.

6. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961. 21:1440–1447.

7. Choo V. WHO reassesses appropriate body-mass index for Asian populations. Lancet. 2002. 360:235.

8. American Diabetes Association. The American Diabetes Association (ADA) has been actively involved in the development and dissemination of diabetes care standards, guidelines, and related documents for many years. Introduction. Diabetes Care. 2009. 32:Suppl 1. S1–S2.

9. Weerakiet S, Srisombut C, Bunnag P, Sangtong S, Chuangsoongnoen N, Rojanasakul A. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int J Gynaecol Obstet. 2001. 75:177–184.

10. Chen X, Yang D, Li L, Feng S, Wang L. Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome. Hum Reprod. 2006. 21:2027–2032.

11. Gambineri A, Pelusi C, Manicardi E, Vicennati V, Cacciari M, Morselli-Labate AM, et al. Glucose intolerance in a large cohort of mediterranean women with polycystic ovary syndrome: phenotype and associated factors. Diabetes. 2004. 53:2353–2358.

12. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab. 2005. 90:3236–3242.

13. Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod. 2001. 16:1995–1998.

14. Pesant MH, Baillargeon JP. Clinically useful predictors of conversion to abnormal glucose tolerance in women with polycystic ovary syndrome. Fertil Steril. 2011. 95:210–215.

15. Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002. 87:1017–1023.

16. Bhattacharya SM. Abnormal glucose tolerance in polycystic ovary syndrome. J Obstet Gynaecol Res. 2008. 34:228–232.

17. American Diabetes Association. Standards of medical care in diabetes: 2007. Diabetes Care. 2007. 30:Suppl 1. S4–S41.

18. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002. 346:393–403.

19. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001. 344:1343–1350.

20. Gagnon C, Baillargeon JP. Suitability of recommended limits for fasting glucose tests in women with polycystic ovary syndrome. CMAJ. 2007. 176:933–938.

21. Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH. The natural history of impaired glucose tolerance in the Pima Indians. N Engl J Med. 1988. 319:1500–1506.

22. Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, et al. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med. 1993. 329:1988–1992.

23. Möhlig M, Spranger J, Ristow M, Pfeiffer AF, Schill T, Schlösser HW, et al. Predictors of abnormal glucose metabolism in women with polycystic ovary syndrome. Eur J Endocrinol. 2006. 154:295–301.