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From the Clinical Research Centers |
Departments of Obstetrics and Gynecology (R.S.L., W.C.D.) and Health Evaluation Sciences (A.R.K.), Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and the Division of Women’s Health, Departments of Medicine and Obstetrics and Gynecology, Brigham and Women’s Hospital (A.D.), Boston, Massachusetts 02115
Address all correspondence and requests for reprints to: Andrea Dunaif, M.D., Division of Women’s Health, PBB-5, 75 Francis Street, Brigham and Women’s Hospital, Boston, Massachusetts 02115. E-mail: adunaif{at}bics.bwh.harvard.edu
Women with polycystic ovary syndrome (PCOS) are insulin resistant, have
insulin secretory defects, and are at high risk for glucose
intolerance. We performed this study to determine the prevalence of
glucose intolerance and parameters associated with risk for this in
PCOS women. Two-hundred and fifty-four PCOS women, aged 14–44 yr, were
prospectively evaluated at 2 centers, 1 urban and ethnically diverse
(n = 110) and 1 rural and ethnically homogeneous (n = 144).
The rural PCOS women were compared to 80 control women of similar
weight, ethnicity, and age. A 75-g oral glucose challenge was
administered after a 3-day 300-g carbohydrate diet and an overnight
fast with 0 and 2 h blood samples for glucose levels. Diabetes was
categorized according to WHO criteria. The prevalence of glucose
intolerance was 31.1% impaired glucose intolerance (IGT) and 7.5%
diabetes. In nonobese PCOS women (body mass index, <27
kg/m2), 10.3% IGT and 1.5% diabetes were found. The
prevalence of glucose intolerance was significantly higher in PCOS
vs. control women (
2 = 7.0;
P = 0.01; odds ratio = 2.76; 95% confidence
interval = 1.23–6.57). Variables most associated with
postchallenge glucose levels were fasting glucose levels
(P < 0.0001), PCOS status (P =
0.002), waist/hip ratio (P = 0.01), and body mass
index (P = 0.021). The American Diabetes
Association criteria applied to fasting glucose significantly
underdiagnosed diabetes compared to the WHO criteria (3.2%
vs. 7.5%; 2 = 4.7; P
= 0.046; odds ratio = 2.48; 95% confidence interval =
1.01–6.69). We conclude that 1) PCOS women are at significantly
increased risk for IGT and type 2 diabetes mellitus at all weights and
at a young age; 2) these prevalence rates are similar in 2 different
populations of PCOS women, suggesting that PCOS may be a more important
risk factor than ethnicity or race for glucose intolerance in young
women; and 3) the American Diabetes Association diabetes diagnostic
criteria failed to detect a significant number of PCOS women with
diabetes by postchallenge glucose values.
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