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Cited by 66Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsGestational Diabetes Research and Management

Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution

Open access
Forslund, M, Landin-Wilhelmsen, K, Trimpou, P, Schmidt, J, Brännström, M, Dahlgren, E·2020·Human Reproduction Open
DOI 10.1093/hropen/hoz042PMC PMC6964225
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Abstract

STUDY QUESTION: What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when lifestyle factors were similar to controls. WHAT IS KNOWN ALREADY: Women with PCOS have an increased prevalence of T2DM. STUDY DESIGN, SIZE, DURATION: A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with PCOS (n = 27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38–68 years, served as controls (n = 94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline. MAIN RESULTS AND THE ROLE OF CHANCE: None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P < 0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period. LIMITATIONS, REASONS FOR CAUTION: The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain. WIDER IMPLICATIONS OF THE FINDINGS: Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time. STUDY FUNDING/COMPETING INTEREST(S): The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 24-year follow-up, women with PCOS had a much higher incidence of type 2 diabetes than controls (19% vs 1%), and all PCOS women who developed T2DM were obese with abdominal fat distribution at baseline. Obesity and abdominal fat distribution, rather than hyperandrogenism per se, were the major predictors when lifestyle factors at follow-up were similar to controls.

Key findings

  • At 24-year follow-up, 5/27 women with PCOS (19%) had developed T2DM versus 1/94 controls (1%) (P < 0.01); the unadjusted OR for T2DM with PCOS was 21.14 (95% CI 2.35–190.14).
  • All women with PCOS who developed T2DM were obese (BMI >30 kg/m²) and had WHR >0.85 at baseline; among obese PCOS women, 71% developed T2DM, and among those with WHR >0.85, 56% developed T2DM.
  • Baseline BMI, waist, WHR, serum insulin, and HOMA-IR were higher in PCOS women who later developed T2DM, while testosterone, SHBG, and FAI did not differ; baseline glucose infusion rate was lower in those who later developed T2DM (8 vs 15 mg/kg LBM/min).
  • Lifestyle factors at follow-up were largely similar between PCOS and controls, except PCOS women reported lower high-sugar diet use (P = 0.01); mean yearly increases in BMI and WHR were similar between groups.

Methods

  • Longitudinal and cross-sectional study: 27 women with PCOS diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years), compared with 94 age-matched controls from the WHO MONICA-GOT 2008 sample previously examined in 1995.
  • At baseline and follow-up, participants had blood samples, clinical examination, and structured questionnaires; PCOS women also underwent a hyperinsulinemic euglycemic glucose clamp at baseline.
  • Analyses used Student’s t-test, Mann–Whitney U test, Fisher’s exact test, and multiple logistic regression; post hoc power for the T2DM prevalence difference was 0.91.

Limitations

  • The paper states the small PCOS sample size and recruitment due to infertility or hirsutism make generalization to milder PCOS uncertain.
  • The paper states testosterone was measured by immunoassay, not the gold-standard mass spectrometry method.
  • Evident from the text: controls were not BMI-matched because few women in the general population were obese at that time, and baseline ages/follow-up durations differed between PCOS women and controls (PCOS baseline mean 30 years and 24-year follow-up; controls baseline mean 40 years and 13-year follow-up).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/hropen/hoz042

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There were no differences in development of T2DM between the initial PCOS intervention groups (EO-CA or GnRH analogue treatment in 1992).

    “There were no differences in development of T2DM between the initial PCOS intervention groups (EO-CA or GnRH analogue treatment in 1992) (data not shown).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Women with PCOS who developed T2DM had higher mean S-insulin levels at baseline than women with PCOS who did not develop T2DM (32 mU versus 10 mU/L).

    “Women with PCOS who 24 years later developed T2DM (19%) had higher mean values of BMI (35 kg/m2 versus 26 kg/m2), waist circumference (106 cm versus 84 cm), WHR (0.96 versus 0.80), S-insulin levels (32 mU versus 10 mU/L) and HOMA-IR (9.5 versus 2.0) at baseline than women who did not develop T2DM (Table I).”
    Quote in the paperSubstantial claim
  • Findingown data

    At baseline, mean glucose infusion rates during the glucose clamp test were lower (8 vs 15 mg/kg LBM/min) in women who developed T2DM 24 years later compared to those who did not.

    “The results from the glucose clamp test at baseline showed lower mean glucose infusion rates (8 compared to 15 mg/kg LBM/min) for those who 24 years later developed T2DM versus those who did not.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among women obese at baseline, 71% of obese PCOS women had converted to T2DM compared to 25% of obese controls (P = 0.24).

    “When comparing the women with and without PCOS who were obese at baseline, 71% of the obese PCOS women had converted to T2DM compared to 25% of obese controls (P-value 0.24).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No additional cases of T2DM based on elevated fasting plasma glucose were found.

    “No additional cases of T2DM based on elevated fasting plasma glucose were found.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 22
  • May combine two claims. 23

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Women with PCOS had a lower usage of a high-sugar diet compared to controls (P = 0.01).

    “However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group from the WHO MONICA-GOT 2008 examination is comparable to the PCOS group at the 2016 follow-up despite being examined at a different time.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Mean age at follow-up was 52 years and did not differ between women with PCOS and controls.

    “The mean age at follow-up was 52 years, with no difference between women with PCOS and controls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Women with PCOS used a diet containing less sugar compared with controls (P = 0.01).

    “However, women with PCOS used a diet containing less sugar compared with controls (P = 0.01; Table IV).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All women with PCOS and T2DM had a WHR >0.85, whereas the one control with T2DM had a WHR <0.85.

    “All women (with or without PCOS) who had T2DM diagnosis were obese at follow-up, and all women with PCOS and T2DM also had a WHR >0.85, whereas the one control with T2DM had a WHR <0.85.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a tendency towards higher serum total testosterone in women with PCOS compared to controls (median 0.83 vs 0.62 nmol/L, P = 0.06).

    “At follow-up, there was no difference in levels of SHBG or FAI between PCOS and control groups, but there was a tendency towards higher levels of serum total testosterone among those with PCOS (median for S-testosterone for women with PCOS 0.83 nmol/L compared to 0.62 nmol/L in controls, P = 0.06; Table IV).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No differences in annual change (delta) in BMI or WHR were seen between PCOS and controls; BMI increase was 0.15 kg/m2/year for both groups, and delta WHR was 0.003/year in PCOS and 0.004/year in controls.

    “No differences in delta values were seen, with a BMI increase of 0.15 kg/m2/year for both groups and delta WHR 0.003/year in PCOS and 0.004/year in controls (Table III).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At follow-up, there was no difference between women with PCOS and controls in sedentary lifestyle during leisure time or at work, use of a Mediterranean diet, or a diet with a high content of saturated fat.

    “At follow-up, there was no difference between women with PCOS and controls when analyzing sedentary lifestyle during leisure time or at work, use of a Mediterranean diet or a diet with a high content of saturated fat.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At baseline, none of the women with PCOS had diabetes mellitus; in the control group, one (1%) had type 1 diabetes and none had T2DM.

    “At baseline, none of the women with PCOS had diabetes mellitus, while in the control group one (1%) had type 1 diabetes mellitus and none had T2DM.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    At baseline, women with PCOS were on average 10 years younger than controls (30 vs 40 years).

    “Since the examination at baseline occurred at a younger age for women with PCOS, there was a 10-year difference in mean age at baseline: 30 years for women with PCOS compared to 40 years for controls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Women with PCOS had a significantly higher BMI and WHR both at baseline and at follow-up, but this difference compared to controls occurred before mid-fertile age.

    “These women already had obesity, and especially abdominal fat distribution, at baseline in the mid-fertile age.”
    • Also stated in: § Discussion · plain
      “Our results show that women with PCOS had a significantly higher BMI and WHR both at baseline and at follow-up, but that this difference compared to controls occurred before mid-fertile age.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the present study, only those with a BMI > 30 kg/m2 at initial assessment had developed T2DM at 24-year follow-up, and this was also true for the single control who developed T2DM.

    “In the present study, where the women with PCOS were initially recruited from a hospital setting, only those with a BMI > 30 kg/m2 (i.e. obese) at the initial assessment had developed T2DM at the 24-year follow-up, but this was also true for the single control who developed T2DM.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The prevalence of T2DM in the control group was lower (1%) compared to the Finnish control group (4%), which could at least partly be explained by the lower mean BMI in the control group in the present study.

    “The prevalence of T2DM in the control group was lower (1%) compared to the Finnish control group (4%), which could at least partly be explained by the lower mean BMI in the control group in the present study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No difference was seen regarding sedentary lifestyle between women with PCOS and controls at follow-up, which supports previous findings from a younger cohort (mean age 34) and an older cohort (mean age 71).

    “No difference was seen regarding sedentary lifestyle, which supports previous findings from a younger cohort of women with PCOS with a mean age of 34 years (Moran et al., 2017), and also that of an older cohort with a mean age of 71 years (Schmidt et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Moran et al., 2017

      Not checked in the free run.

    • cites Schmidt et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women with PCOS have an increased risk or prevalence of type 2 diabetes mellitus (T2DM).

    “Women with PCOS have an increased prevalence of T2DM.”
    • Also stated in: § Introduction · plain
      “A meta-analysis from 2018 showed an increased risk for impaired glucose tolerance (IGT) and increased risk for type 2 diabetes mellitus (T2DM), with three times increased odds of IGT (Kakoly et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kakoly et al., 2018 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The increased risk for impaired glucose tolerance in women with PCOS is present regardless of whether women with PCOS and controls are matched for BMI.

    “The risk for IGT was increased regardless of whether women with PCOS and controls were matched for BMI or not, while on the other hand, the increased risk for overt T2DM was not significant if the groups were matched for BMI (Kakoly et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kakoly et al., 2018 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The increased risk for overt T2DM in women with PCOS is not significant when groups are matched for BMI.

    “The risk for IGT was increased regardless of whether women with PCOS and controls were matched for BMI or not, while on the other hand, the increased risk for overt T2DM was not significant if the groups were matched for BMI (Kakoly et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kakoly et al., 2018 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The odds of impaired glucose tolerance are three times higher in women with PCOS.

    “A meta-analysis from 2018 showed an increased risk for impaired glucose tolerance (IGT) and increased risk for type 2 diabetes mellitus (T2DM), with three times increased odds of IGT (Kakoly et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kakoly et al., 2018 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In peri- and postmenopausal women with PCOS, the risk of T2DM remains increased.

    “The results from this review suggested that the risk of T2DM remained increased in peri- and postmenopausal women with PCOS, although the results were diverse if adjusted or matched for BMI (Cooney and Dokras, 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cooney and Dokras, 2018 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Menopause influences metabolism, with increased insulin resistance and changes in lipid metabolism with increasing lipid levels.

    “The menopause also influences metabolism, with increased insulin resistance and changes in lipid metabolism with increasing lipid levels (Mauvais-Jarvis et al., 2013; Paschou and Papanas, 2019; Paschou et al., 2019).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Mauvais-Jarvis et al., 2013 source

      Not checked in the free run.

    • cites Paschou and Papanas, 2019

      Not checked in the free run.

    • cites Paschou et al., 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    With α = 0.05 and the prevalence found in this study (19% versus 1%), the study had an achieved power of 0.91.

    “With α = 0.05 and the prevalence found in this study (19% versus 1%) this gave an achieved power of 0.91.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Most studies in the 2018 meta-analysis were cross-sectional and included mainly women around the age of 30 years and younger.

    “Most of the studies included in the meta-analysis were cross-sectional and included mainly women around the age of 30 years and younger, and only two of the included studies examined women with a mean age above 50 years (Kakoly et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kakoly et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The women with PCOS also fulfilled the previously used NIH criteria and thereby the Rotterdam criteria, including the updated definition.

    “Thus, they also fulfilled the previously used NIH criteria and thereby the Rotterdam criteria, including the updated definition (Fauser et al., 2004; Teede et al., 2018).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Fauser et al., 2004 source

      Not checked in the free run.

    • cites Teede et al., 2018 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The lack of significance in the previous study might be due to similar BMI between groups and controls catching up in WHR during the 21-year follow-up.

    “The lack of significance might be due to the similar BMI between groups in that study and the fact that controls caught up in WHR during the 21-year follow-up period (Schmidt et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Schmidt et al., 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The food frequency questionnaire used was similar to one validated in the Northern Sweden Health and Disease Cohort.

    “A similar FFQ has been used and validated in the Northern Sweden Health and Disease Cohort (Johansson et al., 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johansson et al., 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    T2DM diagnoses were verified in medical records and all women with T2DM used antiglycemic drugs.

    “The T2DM diagnosis was also verified in medical records and all women with T2DM used antiglycemic drugs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mass spectrometry only minimally improves discrimination of women with and without PCOS compared with a direct testosterone immunoassay.

    “It has previously been shown that mass spectrometry only minimally improves discrimination of women with and without PCOS compared with a direct testosterone immunoassay (Handelsman et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Handelsman et al., 2017 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Another limitation is that testosterone levels were analyzed with an immunoassay method, which is not considered the gold standard.

    “Another limitation is that the testosterone levels were analyzed with an immunoassay method, which is the available method in our laboratory but this is not considered the gold standard.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The new guidelines for PCOS recommend screening for glycemic status every 1-3 years and in high risk women with PCOS, including women with a BMI >25 kg/m2, an oral glucose tolerance test is recommended.

    “The new guidelines for PCOS recommend screening for glycemic status every 1–3 years and in high risk women with PCOS, including women with a BMI >25 kg/m2, an oral glucose tolerance test is recommended (Teede et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Teede et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    In conclusion, abdominal obesity in PCOS in women of mid-fertile age, but not hyperandrogenism per se, was the major risk factor for T2DM development 24 years later at peri-/postmenopausal age, when lifestyle factors were similar to controls.

    “In conclusion, abdominal obesity in PCOS in women of mid-fertile age, but not the hyperandrogenism per se, was the major risk factor for T2DM development 24 years later at peri-/postmenopausal age, when lifestyle factors were similar to controls.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Women with peripheral fat distribution (WHR ≤ 0.85) irrespective of BMI had a higher glucose disposal rate (16 mg/kg LBM/min), similar to the non-diabetic women with PCOS in the present study.

    “Women with peripheral fat distribution (WHR ≤ 0.85) irrespective of BMI had a higher glucose disposal rate (16 mg/kg LBM/min), similar to the non-diabetic women with PCOS in the present study (Landin et al., 1989).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Landin et al., 1989 source

      Not checked in the free run.

    • Rests on an assumption: The lean mass, mainly skeletal muscle tissue, is the primary target for peripheral glucose uptake.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The strengths of the study were the establishment of PCOS diagnosis during reproductive years, the long follow-up time of 24 years for women with PCOS, all women coming from the same geographical area, and a random population sample of women used as controls.

    “The strengths were the establishment of the PCOS diagnosis during the reproductive years and the long follow-up time of 24 years for the women with PCOS. In addition, all women came from the same geographical area. Furthermore, a random population sample of women used as controls is considered to be the best group for valid comparisons.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    A limitation of this study was the small sample size in the PCOS group and that the women with PCOS were recruited because of infertility or hirsutism, which makes generalization to women with milder forms of PCOS uncertain.

    “A limitation of this study was the small sample size in the PCOS group and that the women with PCOS were recruited because of infertility or hirsutism, which makes generalization to women with milder forms of PCOS uncertain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have shown a tendency towards a healthier diet, including higher use of a Mediterranean diet, in women with PCOS.

    “Previous studies have shown a tendency towards a healthier diet, including higher use of a Mediterranean diet, in women with PCOS (Moran et al., 2015; Moran et al., 2017).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Moran et al., 2015 source

      Not checked in the free run.

    • cites Moran et al., 2017

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The healthier diet in women with PCOS might be due to previous dietary advice, since lifestyle intervention is the first line of treatment for PCOS, but also to the fact that T2DM is more common among women with PCOS and they would then get advice to change their diet.

    “This might be due to previous dietary advice, since lifestyle intervention is the first line of treatment for PCOS, but also to the fact that T2DM is more common among women with PCOS and they would then get advice to change their diet.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    It was impossible to match for BMI owing to the few obese women in the general population at that time.

    “However, this made it impossible to match for BMI owing to the few obese women in the general population at that time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Overweight and obesity, especially when present at a young age, significantly increased the lifetime risk for T2DM in the general population.

    “This is in line with previous studies on the general population where overweight and obesity, especially when present at a young age, significantly increased the lifetime risk for T2DM (Narayan et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Narayan et al., 2007 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a prospective population-based birth-cohort study from Finland, women (aged 46 years) with a history of oligo-/amenorrhea and hirsutism had 2.5 times higher odds of T2DM compared with controls, but no case of T2DM was found in normal weight women with PCOS at this age.

    “In a prospective population-based birth-cohort study from Finland, women (aged 46 years) with a history of oligo-/amenorrhea and hirsutism had 2.5 times higher odds of T2DM compared with controls, but no case of T2DM was found in normal weight women with PCOS at this age (Ollila et al., 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ollila et al., 2017 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One-third of women had to wait more than 2 years after initial contact with the healthcare system to obtain a PCOS diagnosis and nearly one-half had to see ≥3 different physicians before being diagnosed.

    “A recent study showed that one-third of the women had to wait more than 2 years after initial contact with the healthcare system to obtain a PCOS diagnosis and nearly one-half had to see ≥3 different physicians before being diagnosed (Gibson-Helm et al., 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gibson-Helm et al., 2017

      Not checked in the free run.

38 of 38

  • The paper relies on this without support.

    Women with PCOS who were lost to follow-up (deceased or declined participation) did not differ systematically in T2DM risk from those included in the 24-year follow-up.

    “Five of the 33 women with PCOS were deceased and one declined participation. Twenty-seven women with PCOS were included, with an age range of 42–63 years.”

  • The paper relies on this without support.

    The control group from the WHO MONICA-GOT 2008 examination is comparable to the PCOS group at the 2016 follow-up despite being examined at a different time.

    “Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38–68 years, served as controls (n = 94), and they were previously examined in 1995.”

  • The paper relies on this without support.

    The lean mass, mainly skeletal muscle tissue, is the primary target for peripheral glucose uptake.

    “The lean mass, mainly the skeletal muscle tissue, is the primary target for peripheral glucose uptake.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Baseline HOMA-IR subgroup means do not produce the reported overall mean

    Major

    Table I gives HOMA-IR means of 7.8 for five women who developed T2DM and 15.0 for 20 who did not. Their weighted mean is 13.56, not the reported overall mean of 3.5.

    Reported 3.5 · recomputed 13.56

  • Overall baseline glucose maximum exceeds both subgroup maxima

    Minor

    Table I reports an overall maximum plasma glucose of 80 mmol/L, while each of the two subgroups has a maximum of 8.0 mmol/L. The overall maximum cannot exceed both subgroup maxima.

  • Results reverse the baseline HOMA-IR comparison shown in Table I

    Minor

    The Results state that women who developed T2DM had higher baseline HOMA-IR (9.5 versus 2.0), but Table I reports 7.8 for that group and 15.0 for women who did not develop T2DM.

3 of 3

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Authors
Forslund, M., Landin-Wilhelmsen, K., Trimpou, P., Schmidt, J., Brännström, M., & Dahlgren, E.
Affiliations
  • Sahlgrenska University Hospital (SE)
  • Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
  • University of Gothenburg (SE)
Corresponding author
Forslund, M
ORCID
Venue
Human Reproduction Open
Publisher
Oxford University Press (OUP)
Published
2020-01-01
Volume
2020
Issue
1
Pages
hoz042-hoz042
ISSN
2399-3529 (ISSN-L)
DOI
10.1093/hropen/hoz042
PMC
PMC6964225
OpenAlex
W3000325838
Cited by
66
References
34
Citations by year
2026: 4 · 2025: 4 · 2024: 6 · 2023: 20 · 2022: 16 · 2021: 9 · 2020: 6 · 2018: 1
FWCI
7.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Reproduction Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Gothenburg Medical Association (780821, 694291)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
Keywords
type 2 diabetes, polycystic ovary syndrome, obesity, abdominal fat distribution, waist-to-hip ratio, diabetes risk factors, high-sugar diet, Mediterranean diet, physical activity, high-fat diet, insulin resistance, women's health, long-term follow-up, infertility, hirsutism, lifestyle factors, body mass index, WHO MONICA

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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