Abstract
BackgroundPolycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Metabolic aspects of the four PCOS phenotypes remain to be fully defined. The aim of this study was to compare metabolic parameters and insulin resistance among the four PCOS phenotypes defined according to the Rotterdam criteria and to determine predictors of these complications.MethodsA total of 526 reproductive-aged women were included in this observational case–control study. Of these, 263 were diagnosed as a PCOS based on Rotterdam criteria and 263 infertile women with no evidence of PCOS were recruited as controls. Biochemical, metabolic and insulin resistance parameters were compared in the two groups and the frequency of MetS and IR were compared among the four phenotypes. Data were analyzed for statistical significance using Student’s t-test and one way analysis of variance followed by a post-hoc test (least significant difference). Chi-square tests were used to compare proportions. Univariate and multivariate logistic regression analyses were also applied.ResultsIR was identified in 112 (42.6%) of the PCOS women and 45 (17.1%) of the control (P <0.001). There were no significant differences in the frequency of IR and MetS between the four PCOS phenotypes. Homeostatic model assessment for IR (HOMA-IR) ≥3.8 was the most common IR parameter in PCOS and control groups. Women with oligo-anovulation (O) and PCO morphology (P) had a significantly lower level of 2-h postprandial insulin compared to women with O, P and hyperandrogenism (H) phenotypes.Logistic regression analysis showed that body mass index, waist circumference, triglyceride/high-density lipoprotein ratio (cardiovascular risk), HOMA-IR and glucose abnormalities (T2DM) were associated with increased risk of having MetS (P < 0.05).ConclusionsPCOS women with (O + P) show milder endocrine and metabolic abnormalities. Although, there were no significant differences in IR, MetS and glucose intolerance between the four PCOS phenotypes, women with PCOS are at higher risk of impaired glucose tolerance and undiagnosed diabetes.
Highlights
Polycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM)
The prevalence of IR in PCOS patients ranges from 44 to 70% [7,8]. This wide range may be due to several factors, including the heterogeneity of the diagnostic criteria for PCOS employed in these studies [7], the genetic background among the assessed population [9] and differences in the methods used for defining IR [7,10]
Glucose metabolism profiles were significantly different between the groups (P < 0.05); the PCOS group had higher values for fasting insulin, 2-h glucose, 2-h insulin, qualitative insulin sensitivity check index (QUICKI), Homeostatic model assessment for IR (HOMA-IR), fasting glucose/fasting insulin, HOMA-B, Matusda index, ratio of 2-h glucose to 2-h insulin, IR, and MetS than those for the control group
Summary
Polycystic ovary syndrome (PCOS) is associated with an increased risk of insulin resistance (IR), metabolic syndrome (MetS), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). The aim of this study was to compare metabolic parameters and insulin resistance among the four PCOS phenotypes defined according to the Rotterdam criteria and to determine predictors of these complications. More than 50% of women with PCOS are insulin resistant, with an estimated that they have a 5- to 8-fold increased risk of type 2 diabetes mellitus (T2DM) compared with age- and weight-matched controls [2,3]. The presence of chronic anovulation associated with higher androgen levels correlates with lower insulin sensitivity and higher prevalence of cardiovascular risk factors, such as IR, impaired glucose tolerance (IGT), T2DM, dyslipidemia and metabolic syndrome (MetS). The presence of two PCOS phenotypes identified according to the Rotterdam criteria—hyperandrogenism and polycystic ovaries with ovulatory cycles and anovulation and polycystic ovaries without hyperandrogenism—show little or no evidence of IR using surrogate markers [7]
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