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
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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 (chi2 = 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%; chi2 = 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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Women with PCOS exhibit increased risk of impaired glucose tolerance and type 2 diabetes mellitus regardless of weight and age.
“As such, women with PCOS exhibit increased risk of impaired glucose tolerance and T2DM regardless of weight and age [20].”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [20]
Many women with PCOS also present evidence of glucose intolerance.
“Approximately 50–70% of women with PCOS have IR and hyperinsulinaemia [128], whereas many also present evidence of glucose intolerance [20].”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [20]
In women with PCOS, dysglycemia typically consists of impaired glucose tolerance.
“In women with PCOS, dysglycemia typically consists of impaired glucose tolerance [12], its prevalence being of almost 30% in both adult women [13] and affected adolescents [14].”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [12]
PCOS patients commonly have metabolic complications, such as type 2 diabetes, insulin resistance (IR), and adipose tissue dysfunction.
“PCOS patients commonly have metabolic complications, such as type 2 diabetes, insulin resistance (IR), and adipose tissue dysfunction (7–9).”
From Circulating Adipokine Levels in Nonobese Women with Polycystic Ovary Syndrome and in Nonobese Control Women: A Systematic Review and Meta-Analysis (2021) · cites this paper as [7]
Women with PCOS generally have hyperandrogenism and lower SHBG.
“However, women with PCOS generally have hyperandrogenism and lower SHBG [52] and differences at the end of the intervention are again likely related to baseline differences.”
From Weight management interventions in women with and without PCOS: a systematic review (2017) · cites this paper as [52]
Differences in total testosterone and SHBG at the end of the intervention between women with and without PCOS are likely related to baseline differences.
“However, women with PCOS generally have hyperandrogenism and lower SHBG [52] and differences at the end of the intervention are again likely related to baseline differences.”
From Weight management interventions in women with and without PCOS: a systematic review (2017) · cites this paper as [52]
In PCOS, other novel CVD risk factors, premature cardiovascular dysfunction and subclinical CVD have been noted and are related to IR and obesity.
“In PCOS, other novel CVD risk factors, premature cardiovascular dysfunction and subclinical CVD 29,30,83 have been noted and are related to IR and obesity. 84-89”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [85]
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Zhu, T., Cui, J., & Goodarzi, M. O. (2021) · Diabetes · doi:10.2337/db20-0800 · Cited by 226 · see citing works
Obesity and PCOS: Implications for Diagnosis and Treatment
Legro, R. S. (2012) · Seminars in Reproductive Medicine · doi:10.1055/s-0032-1328878 · Cited by 280 · see citing works
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Adolescent Obesity and Puberty: The “Perfect Storm”
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Polycystic Ovarian Syndrome: Diagnosis and Management
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Exercise therapy in polycystic ovary syndrome: a systematic review
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Insulin and the polycystic ovary syndrome.
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Obesity and Polycystic Ovary Syndrome
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- Authors
- Legro, R. S.
- Affiliations
- Pennsylvania State University (US)
- ORCID
- Legro, R. S.
- Venue
- Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1999-01-01
- Volume
- 84
- Issue
- 1
- Pages
- 165-169
- ISSN
- 0021-972X (ISSN-L)
- OpenAlex
- W2096126402
- Cited by
- 1,743
- References
- 0
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 36 · 2023: 24 · 2022: 50 · 2021: 64 · 2020: 54 · 2019: 42 · 2018: 43 · 2017: 66 · 2016: 59 · 2015: 88 · 2014: 81 · 2013: 73 · 2012: 84
- FWCI
- 44.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion, cc-by)
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK040605)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K08 HD-O118, U54HD034449)
- 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
- polycystic ovary syndrome, type 2 diabetes, impaired glucose tolerance, insulin resistance, insulin secretion, diabetes risk factors, prevalence, fasting blood glucose, waist-to-hip ratio, body mass index, ethnic differences, diagnostic criteria, underdiagnosis, oral glucose tolerance test, young women, obesity
- MeSH terms
- Adolescent, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Polycystic Ovary Syndrome, Prospective Studies, Risk, Body Mass Index, Prevalence
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