Abstract
Data concerning metabolic consequences in women with polycystic ovary syndrome (PCOS) are delivered mainly by cross-sectional studies. In this research, we re-examined 31 Caucasian PCOS women after a median period of 120.9 months to evaluate the changes in metabolic syndrome components. Clinical examination, oral glucose tolerance test with estimations of glucose and insulin, lipids, sex hormone-binding globulin (SHBG) and sex hormones assessments were performed on two occasions. Additionally, the euglycaemic hyperinsulinaemic clamp technique was used at the baseline to assess insulin sensitivity (M-clamp value). In the end, the median age of participants was 35. We observed an increase in glucose concentrations, a decrease in insulin concentrations and no changes in insulin resistance markers. Final mean glucose, mean insulin, Matsuda index and body mass index (BMI) were correlated with baseline M-clamp value and SHBG (p < 0.01). During the follow-up, no one in the sample developed diabetes. The annualised incidence rate for conversion from normoglycaemia to prediabetes totalled 4.5%. Baseline BMI, free androgen index, fasting glucose and M-clamp value were identified as prediabetes predictors in young PCOS women (respectively, OR = 1.17, OR = 1.42, OR = 1.2, OR = 0.73, p < 0.05). Prediabetes appeared in 76.47% of the women with a final BMI of ≥ 25 kg/m2 and in 7.14% of the normal-weight women (p = 0.0001). In conclusion, we report a high rate of adverse change in glucose metabolism in overweight and obese participants, a deterioration in β-cell function and strong correlations between metabolic parameters assessed in the third and the fourth decade in PCOS women, emphasising the role of early intervention to prevent cardiometabolic diseases.
Highlights
Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder among women of reproductive age with various prevalence and manifestation among populations [1,2,3]
It is well established that insulin resistance (IR) and compensatory hyperinsulinaemia are central aetiological abnormalities in women with PCOS which lead to the overproduction of ovarian and adrenal androgens and an increase in androgen bioavailability through inhibition of sex hormone-binding globulin (SHBG) secretion [10]
Cassar et al in a meta-analysis of 28 articles concerning insulin sensitivity estimated with the euglycaemic hyperinsulinaemic clamp found that IR is the intrinsic feature of PCOS and that insulin sensitivity is 27% lower in women with PCOS compared to controls, independently of body mass index (BMI) [13]
Summary
Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder among women of reproductive age with various prevalence and manifestation among populations [1,2,3]. In the last few years, different sets of diagnostic criteria were proposed and currently, the revised Rotterdam criteria are recommended [4]. The nature of PCOS is multifactorial and heterogeneous. Environmental factors such as prenatal androgen exposure, poor fetal growth, high carbohydrate consumption and acquired obesity interact with genetic origins and contribute to PCOS pathogenesis [5,6,7,8,9]. Cassar et al in a meta-analysis of 28 articles concerning insulin sensitivity estimated with the euglycaemic hyperinsulinaemic clamp found that IR is the intrinsic feature of PCOS and that insulin sensitivity is 27% lower in women with PCOS compared to controls, independently of body mass index (BMI) [13]. The importance of insulin resistance phenomenon regardless of body weight was provided by several authors [14,15]
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