Higher risk of type 2 diabetes in women with hyperandrogenic polycystic ovary syndrome

Women with hyperandrogenic polycystic ovary syndrome (PCOS) have a higher risk of developing type 2 diabetes than women with normoandrogenic PCOS and non-PCOS women, when adjusting for body mass index.

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VOLUME 116, ISSUE 3, P862-871

Authors:

Sofia Persson, M.D., Evangelia Elenis, M.D., Ph.D., Sahruh Turkmen, M.D., Ph.D., Michael S. Kramer, Ph.D., Eu-Leong Yong, M.D., Inger Sundström Poromaa, M.D.

Abstract:

Objective

To assess the risk of type 2 diabetes (T2D) in women with polycystic ovary syndrome (PCOS) in relation to body mass index (BMI) and the hyperandrogenic (HA) PCOS phenotype.


Design

Population-based cohort study.


Setting

Data from six Swedish national registers, with participants being followed for a maximum of 19 years.


Patient(s)

All women with an International Statistical Classification of Diseases and Related Health Problems, version 10, diagnosis of PCOS, androgen excess, or anovulatory infertility born between 1950 and 1999 (n = 52,535) were identified in the Patient Register. The HA PCOS phenotype was defined by two filled prescriptions for anti-androgenic drugs. For each woman with PCOS, five control women (n = 254,624) were randomly chosen from the Total Population Register, matched for age and geographic area.


Intervention(s)

No interventions were performed.


Main Outcome Measure(s)

International Statistical Classification of Diseases and Related Health Problems, version 10, diagnosis of T2D or prescription of antidiabetic treatment other than metformin.


Result(s)

The cumulative incidence rates of T2D were 1.3%, 4.4%, and 14.2% in controls (non-PCOS women) and women with normoandrogenic (NA) and HA PCOS, respectively. After adjustment for BMI, women with PCOS had a twofold higher rate of T2D than non-PCOS women (adjusted hazard ratio, 2.52 [95% confidence interval, 2.15–2.96]). Women with HA PCOS had a higher rate of T2D than those with NA PCOS (adjusted hazard ratio, 3.86 [95% confidence interval, 3.16–4.72]).


Conclusion(s)

Polycystic ovary syndrome is an independent risk factor for T2D, even after adjustment for BMI. Women with the HA PCOS phenotype face an even higher risk of T2D than those with the NA PCOS phenotype.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 

Comments

Go to the profile of Pandiyan  Natarajan
about 1 month ago

Hyper androgenism, Type 2 Diabetes Mellitus and Poly Cystic Ovarian Syndrome are all consequences of Abnormal Weight gain.

Any weight gain in adult life, besides Pregnancy and Body building is abnormal. The earliest manifestation of such abnormal weight gain is, ‘ Irregular menstrual cycles,’ which over time progresses to Anovulation and subsequently to Poly Cystic Ovarian Syndrome-PCOS. 

Excess body weight is individualistic. The standard to compare is the body weight projection from birth and particularly in early adulthood. Any weight gain after that is abnormal and has consequences. BMI is a poor indicator of overweight and Obesity. Abnormal weight gain is the primary cause of Poly cystic Ovarian syndrome. (1) (2)

Obesity and consequent increase in Insulin are risk factors for Hyperandrogenism. Obesity also reduces Sex Hormone Binding Globulin SHBG and increases the bio availability of Free Testosterone. Obesity, Overweight and Excess body weight are risk factors for Type 2 Diabetes Mellitus. The primary causative factor for Hyperandrogenemia and Type 2 Diabetes Mellitus is Excess weight or Overweight or Obesity and not PCOS per se.

1) Is Weight Gain the Precipitating Factor for Polycystic Ovarian Syndrome?
A Hypothesis Based on a Retrospective Study.

Puvithra T, Pandiyan N.

Chettinad Health City Medical Journal 2015; 4(3): 120 - 124

https://www.chcmj.ac.in/pdf/vol4_no3/Is_Weight_Gain.pdf

2) Polycystic Ovary Syndrome is an Epiphenomenon - An Opinion

Puvithra T, Pandiyan N.

Chettinad Health City Medical Journal 2016; 5(3): 106 - 107

https://www.chcmj.ac.in/pdf/vol5_no3/polycystic_ovary.pdf

Professor Dr Pandiyan Natarajan,

Professor and Head of the Department of Andrology and Reproductive Medicine,

Chettinad Super Speciality Hospital,

Chettinad Academy of Research and Education,

Kelambakkam,

Chennai, Tamil Nadu,

India-603103