Is Oral Glucose Tolerance Test Necessary in Lean Women with Polycystic Ovary Syndrome?

Presentation Number: OR11-6
Date of Presentation: April 1st, 2017

Rasa Pelanis*1, Marianne Andersen2, Inger Sundström Poromaa3, Pernille Ravn2, Laure Morin-Papunen4, Terhi Piltonen4, Johanna Puurunen5, Angelica Lindén Hirschberg6, Juha Tapanainen7, Dorte Glintborg2 and Jan Mellembakken1
1Oslo University Hospital, Oslo, Norway, 2Odense University Hospital, Odense, Denmark, 3Uppsala University, Uppsala, Sweden, 4University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland, 5Oulu University Hospital, University of Oulu, Oulu, Finland, 6Karolinska Institute, Stockholm, Sweden, 7Helsinki University Hospital and University of Helsinki, Finland

Abstract

Abstract: Insulin resistance in polycystic ovary syndrome (PCOS) is associated with an increased prevalence of type 2 diabetes (T2D) and prediabetes. Guidelines from the Endocrine Society recommend an oral glucose tolerance test (OGTT) upon diagnosis. Previous studies have shown that women with PCOS are more insulin resistant than controls, and that the risk of T2D and prediabetes are closely linked to obesity, certain ethnicities and older age.

Aim: To investigate the risk of T2D and prediabetes in lean women with PCOS, and whether to use age, ethnicity and androgen concentration as additional screening criteria.

Design:Cross-sectional study in 1068 premenopausal Scandinavian women with PCOS. All included women underwent a 2h OGTT measuring baseline fasting glucose and 2h glucose. T2D and prediabetes were diagnosed according to American Diabetes Association’s recommendations. 839 women were white-European (WE), 69 were Indian-Pakistani and 160 were of other ethnicities. None had previously been diagnosed with T2D, were pregnant, or had other serious endocrine diseases. Testosterone was measured using mass spectrometry.

Results: 0/356 (0%) lean women (BMI<25 kg/m2) with PCOS in our study had T2D, and 47/356 (13.2%) had prediabetes. In women with BMI 25-30 kg/m2, 4/271 (1.5 %) had T2D and 76/271 (27.8%) had prediabetes. In women with BMI >30 kg/m2, 28/438 (6.4%) had T2D and 148/438 (54.6%) had prediabetes.

BMI and waist to hip ratio (WHR) were significantly associated with the risk of T2D and prediabetes. Indian-Pakistani women had a 3.2 higher relative risk of T2D (p=0.006) and 1.7 higher relative risk of prediabetes (p=0.002) compared to WE women (mean BMI 28.8 kg/m2 for both ethnicities). Age and androgen concentration (measured by both total testosterone and free androgen index) were not associated with the prevalence of T2D although older age and lower testosterone were significantly associated with the prevalence of prediabetes.

Conclusion: No women with PCOS and BMI<25 kg/m2 had T2D. Our data suggest that OGTT is not necessary in normal-weight women with PCOS. The present data underline the need for prospective studies in well described study cohorts with PCOS.

 

Nothing to Disclose: RP, MA, IS, PR, LM, TP, JP, ALH, JT, DG, JM