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Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome.
Abstract
OBJECTIVE: NIDDM occurs commonly among women with polycystic ovary syndrome (PCOS). The prevalence and natural history of its precursor, impaired glucose tolerance (IGT), is less well known. The objective of this study was to characterize the prevalence and incidence of glucose intolerance in a large cohort of women with well-characterized PCOS. RESEARCH DESIGN AND METHODS: A total of 122 women with clinical and hormonal evidence of PCOS were recruited from the Medicine, Endocrinology, Gynecology, and Pediatrics Clinics at the University of Chicago. All women had a standard oral glucose tolerance test (OGTT) with measurement of glucose and insulin levels. A subset of 25 women were subsequently restudied with the aim of characterizing the natural history of glucose tolerance in PCOS. RESULTS: Glucose tolerance was abnormal in 55 (45%) of the 122 women: 43 (35%) had IGT and 12 (10%) had NIDDM at the time of initial study. The women with NIDDM differed from those with normal glucose tolerance in that they had a 2.6-fold higher prevalence of first-degree relatives with NIDDM (83 vs. 31%, P < 0.01 by chi 2) and were significantly more obese (BMI 41.0 +/- 2.4 vs. 33.4 +/- 1.1 kg/m2, P < 0.01). For the entire cohort of 122 women, there was a significant correlation between fasting and 2-h glucose concentrations (r = 0.76, P < 0.0001); among the subset with IGT, the fasting glucose concentration was poorly predictive of the 2-h level (r = 0.25, NS). After a mean follow-up of 2.4 +/- 0.3 years (range 0.5-6.3), 25 women had a second OGTT. The glucose concentration at 2 h during the second glucose tolerance test was significantly higher than the 2-h concentration during the first study (161 +/- 9 vs. 139 +/- 6 mg/dl, P < 0.02). CONCLUSIONS: The prevalence of IGT and NIDDM in women with PCOS is substantially higher than expected when compared with age- and weight-matched populations of women without PCOS. The conversion from IGT to NIDDM is accelerated in PCOS. The fasting glucose concentration does not reliably predict the glucose concentration at 2 h after an oral glucose challenge, particularly among those with IGT, the subgroup at highest risk for subsequent development of NIDDM. We conclude that women with PCOS should periodically have an OGTT and must be closely monitored for deterioration in glucose tolerance.
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“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 [13]
In the citing paper
“Earlier-onset hyperglycaemia and rapid progression to DM2 is also reported in PCOS. 104,105”
From Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline (2011) · cites this paper as [104]
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BackgroundINSULIN-LOWERING THERAPEUTIC MODALITIES FOR POLYCYSTIC OVARY SYNDROME
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“, up to 80% of PCOS women are obese (28, 69), a percentage much higher than observed in the general population.”
BackgroundResultThe prevalence of Type 2 diabetes is not increased in normal-weight women with PCOS
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BackgroundImplications of circulating irisin and Fabp4 levels in patients with polycystic ovary syndrome
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BackgroundWhy does Polycystic Ovary Syndrome (PCOS) Need Long-term Management?
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MethodAlexandraki, K., Protogerou, A. D., Papaioannou, T., Piperi, C., Mastorakos, G. P., Lekakis, J. P., Panidis, D., & Diamanti‐Kandarakis, E. (2006) · HORMONES · doi:10.14310/horm.2002.11176 · Cited by 43
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BackgroundThe nature of FSH induction by GnRH
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“In patients with this condition, there is some degree of insulin resistance, and this is independent of obesity in women [76, 77] and ranges from impaired glucose tolerance to overt type-2 diabetes with increased risk in women with a family history of diabetes [78–82].”
BackgroundDiabetes risk score in the diagnostic categories of polycystic ovary syndrome
Moran, L. J., Strauss, B. J., & Teede, H. J. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.01.133 · Cited by 41
“Elevated diabetes risk in PCOS is associated with factors including peripheral insulin resistance, elevated b-cell function, adiposity, abdominal adiposity, age, androgens, history of gestational diabetes, and family history of DM2 (6, 17, 37).”
BackgroundReyes-Muñoz, E., Ortega-González, C., Martínez-Cruz, N., Arce-Sánchez, L., Estrada‐Gutiérrez, G., Morán, C., Sánchez-Serrano, A. P., Higareda-Sánchez, R., & la Jara-Díaz, J. F. D. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012107 · Cited by 41
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BackgroundLin, T.-C., Yen, J.-M., Gong, K.-B., Kuo, T., Ku, D.-C., Liang, S., & Wu, M. (2006) · BMC Medical Genetics · doi:10.1186/1471-2350-7-36 · Cited by 42
“%) in the report of Ermann et al [29].”
ResultFactors Contributing to Initial Weight Loss Among Adolescents with Polycystic Ovary Syndrome
Geier, L. M., Bekx, M. T., & Connor, E. L. (2012) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2012.06.008 · Cited by 40
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“endometrial cancer [6–8].”
Glucose tolerance abnormalities in Australian women with polycystic ovary syndrome
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“In the 90s, Ehrmann et al noted that women with PCOS whose glucose tolerance deteriorated had significantly higher BMI than the rest of the cohort.(66) Two years later, Norman et al considered baseline BMI as an independent significant predictor of adverse change in glycaemic control – it was counted that overweight a…”
BackgroundMethodResultInfluentialThe contentious nature of gestational diabetes: diet, insulin, glyburide and metformin
Glueck, C. J., Goldenberg, N., Streicher, P., & Wang, P. (2002) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.3.11.1557 · Cited by 38
“The prevalence of impaired glucose tolerance and type 2 DM in PCOS is much higher than in age- and weight-matched women without PCOS [49].”
BackgroundCibula, D., Hill, M., Fanta, M., Šindelka, G., & Zivny, J. (2001) · Human Reproduction · doi:10.1093/humrep/16.5.940 · Cited by 38
“Obesity itself negativelydependent diabetes mellitus (NIDDM) and coronary artery influences the synthesis of sex hormone-binding globulindisease (Dahlgren et al., 1992; Ehrmann et al., 1999; Legro (SHBG), androgen production, and insulin sensitivity (Kurtzet al., 1999; Cibula et al., 2000).”
BackgroundGenetic Basis of Metabolic Abnormalities in Polycystic Ovary Syndrome
Rold??n, B., n, J. L. S. M., & Escobar-Morreale, H. F. (2004) · American Journal of PharmacoGenomics · doi:10.2165/00129785-200404020-00004 · Cited by 39
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“Studies have shown that there is a defect in the glucose-stimulated insulin secretion [7–9], but other studies have found that insulin response is enhanced in women with PCOS, likely as compensation for the peripheral insulin resistance [10–12].”
BackgroundGenazzani, A. D. (2014) · Endocrinology & Metabolic Syndrome · doi:10.4172/2161-1017.1000140 · Cited by 36
“Indeed, conversion from normal glucose tolerance to hyperinsulinemia due to impaired glucose tolerance and later to type II diabetes is accelerated in PCOS patients [8-13].”
BackgroundSivayoganathan, D., Maruthini, D., Glanville, J. M., & Balen, A. H. (2011) · Human Fertility · doi:10.3109/14647273.2011.632058 · Cited by 36
“An American study of 122 patients with PCOS attending four different clinics (medicine, endocrine, gynaecology and paediatrics) (Ehrmann et al., 1999) also found that GTT results were abnormal in 45% (35% IGT, 10% diabetes), which is not dissimilar to our finding of an abnormal GTT in 38% (29% IGT, 9% diabetes).”
ResultMetformin and gestational diabetes
Glueck, C. J., Goldenberg, N., Streicher, P., & Wang, P. (2003) · Current Diabetes Reports · doi:10.1007/s11892-003-0022-0 · Cited by 38
“Related in part to the insulin resistance characteristic of PCOS, the prevalence of impaired glucose tolerance and type 2 DM in PCOS is much higher than in age- and weight-matched women without PCOS [ 38 ].”
BackgroundMarinkovic-Radosevic, J., Cigrovski Berkovic, M., Kruezi, E., Bilic-Curcic, I., & Mrzljak, A. (2021) · World Journal of Diabetes · doi:10.4239/wjd.v12.i7.932 · Cited by 35
Juan, C., Chen, K.-H., Wang, P., Hwang, J., & Seow, K. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2015.03.027 · Cited by 36
Saxena, R., Georgopoulos, N. A., Braaten, T. J., Bjonnes, A., Koika, V., Panidis, D., & Welt, C. K. (2015) · Human Reproduction · doi:10.1093/humrep/dev085 · Cited by 36
Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?
Andersen, M., & Glintborg, D. (2018) · European Journal of Endocrinology · doi:10.1530/eje-18-0237 · Cited by 38
Cardio‐metabolic risk factors among young infertile women: a systematic review and meta‐analysis
Mulder, C. L., Lassi, Z. S., Grieger, J. A., Alı̀, A., Jankovic‐Karasoulos, T., Roberts, C. T., & Andraweera, P. H. (2020) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16171 · Cited by 36
Petríková, J., Lazúrová, I., Dravecká, I., Vrbíková, J., Kozáková, D., Figurová, J., Vaczy, Z., & Rosocha, J. (2014) · Biomedical Papers · doi:10.5507/bp.2014.062 · Cited by 36
Glintborg, D., Mumm, H., Ravn, P., & Andersen, M. (2012) · Hormone and Metabolic Research · doi:10.1055/s-0032-1304608 · Cited by 36
Polycystic ovary syndrome. Revised diagnostic criteria and long-term health consequences
Kousta, E., Tolis, G., & Franks, S. (2005) · HORMONES · doi:10.14310/horm.2002.11151 · Cited by 35
FTO gene variants are not associated with polycystic ovary syndrome in women from Southern Brazil
Ramos, R. B., & Spritzer, P. M. (2015) · Gene · doi:10.1016/j.gene.2015.01.012 · Cited by 35
Targeting insulin sensitivity in the treatment of polycystic ovary syndrome
Pasquali, R., & Gambineri, A. (2009) · Expert Opinion on Therapeutic Targets · doi:10.1517/14728220903190699 · Cited by 35
“We recently performed a study [61] to investigate the prevalence of the metabolic syndrome in 200 Caucasian women with PCOS and 200 non-PCOS women, matched for age and BMI, and the concordance using either of the currently proposed definitions (National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP…”
Charnvises, K., Weerakiet, S., Tingthanatikul, Y., Wansumrith, S., Chanprasertyothin, S., & Rojanasakul, A. (2005) · Gynecological Endocrinology · doi:10.1080/09513590500216776 · Cited by 35
“Also, this factor can predict the development of type 2 DM [32] and may be better for this purpose than BMI [33].”
BackgroundInfluentialHager, M., Nouri, K., Imhof, M., Egarter, C., & Ott, J. (2019) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-019-05194-w · Cited by 39
Vrbíková, J., Dvorakova, K., Grimmichová, T., Hill, M., Stanická, S., Cibula, D., Bendlová, B., Stárka, L., & Vondra, K. (2007) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2007.113 · Cited by 35
Association of CAPN10 SNPs and Haplotypes with Polycystic Ovary Syndrome among South Indian Women
Dasgupta, S., Sirisha, P. V. S., Neelaveni, K., Katragadda, A., & Reddy, B. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0032192 · Cited by 35
“In addition to the clinical features of hyperandrogenism and chronic anovulation, many women are insulin resistant and at increased risk for type-2 diabetes mellitus (T2DM) [1].”
BackgroundKulshreshtha, B., Ganie, M. A., Praveen, E. P., Gupta, N., Khurana, M. L., Seith, A., Dwivedi, S. N., Kumar, G., & Ammini, A. C. (2008) · Gynecological Endocrinology · doi:10.1080/09513590802342858 · Cited by 35
“In spite of lower BMI and age, the prevalences of glucose intolerance and T2DM are comparable to those reported from the USA.”
BackgroundInfluentialChildhood obesity: a growing public health concern
Must, A., Hollander, S. A., & Economos, C. D. (2006) · Expert Review of Endocrinology & Metabolism · doi:10.1586/17446651.1.2.233 · Cited by 35
Suitability of recommended limits for fasting glucose tests in women with polycystic ovary syndrome
Gagnon, C., & Baillargeon, J.-P. (2007) · Canadian Medical Association Journal · doi:10.1503/cmaj.060607 · Cited by 33
“5%–10%.(18,19) In conclusion, our results demonstrate that the fasting glucose test is not sufficiently sensitive to be used to screen for abnormal glucose tolerance in women with polycystic ovary syndrome.”
BackgroundResultLuque‐Ramírez, M., Alpañés, M., & Escobar-Morreale, H. F. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.11.049 · Cited by 34
Amato, M. C., Magistro, A., Gambino, G., Vesco, R., & Giordano, C. S. D. S. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0600 · Cited by 34
“…and hyperandrogenism (clinical and bio-chemical), PCOS is also associated with insulin resistance (4, 5) and an increased risk of glucose intolerance and type 2 diabetes mellitus (T2DM) (6, 7, 8), dyslipidemia, subclinical atherosclerosis, and vascular dysfunction, independently of BMI (5).”
Carmina, E., Nasrallah, M., Guastella, E., & Løbo, R. A. (2019) · Clinical Endocrinology · doi:10.1111/cen.14063 · Cited by 34
Metadata
- Authors
- Ehrmann, D. A., Barnes, R. B., Rosenfield, R. L., Cavaghan, M. K., & Imperial, J.
- Affiliations
- University of Chicago (US)
- ORCID
- Rosenfield, R L
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1999-01-01
- Volume
- 22
- Issue
- 1
- Pages
- 141-146
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2007816906
- Cited by
- 1,257
- References
- 0
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 22 · 2023: 18 · 2022: 39 · 2021: 45 · 2020: 32 · 2019: 39 · 2018: 40 · 2017: 45 · 2016: 37 · 2015: 63 · 2014: 63 · 2013: 55 · 2012: 75
- FWCI
- 31.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k08dk002315-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-31842, DK 20595, DK-02315)
- 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, impaired glucose tolerance, type 2 diabetes, prevalence, incidence, natural history (disease), oral glucose tolerance test, fasting blood glucose, obesity, family history of diabetes, women's health
- MeSH terms
- Adult, Analysis of Variance, Blood Glucose, Chicago, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glucose Tolerance Test, Humans, Insulin, Polycystic Ovary Syndrome, Regression Analysis, Testosterone, Prevalence, Glucose Intolerance
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