Polycystic Ovary Syndrome in Girls With Type 2 Diabetes

Abstract

Source: Cioana M, Deng J, Nadarajah A, et al. Prevalence of polycystic ovary syndrome in patients with pediatric type 2 diabetes a systematic review and meta-analysis. JAMA Netw Open. 2022;5(2):e2147454. doi:10.1001/jamanetworkopen.2021.47454Investigators from multiple institutions conducted a meta-analysis to estimate the prevalence of polycystic ovary syndrome (PCOS) in girls with type 2 diabetes (T2D). For the meta-analysis, systematic search procedures were used to identify studies in which the prevalence of PCOS in girls diagnosed with T2D when they were ≤18 years old was estimated. Studies included could have cross-sectional, retrospective, or prospective cohort designs, if they had a minimum sample of 10 patients. No specific criteria for the diagnosis of PCOS were required. The prevalence of PCOS in each included study was determined, and a pooled prevalence was calculated. A secondary analysis that included studies in which specific criteria were required for the diagnosis of PCOS also was conducted. For studies with the available data, the prevalence of PCOS among girls with T2D from different racial groups was calculated.The authors screened 722 articles to identify 6 studies that met the inclusion criteria; 5 of these were retrospective cohort studies. Data on 470 girls were included in the meta-analysis. The mean age at diagnosis of T2D among participants in the included studies ranged from 12.9 years to 16.1 years. Overall, the pooled prevalence of PCOS among adolescent females with T2D was 19.58% (95% CI, 12.02%, 27.14%). Three studies required a history of persistent oligomenorrhea and clinical and/or biochemical hyperandrogenism for a diagnosis of PCOS. Among 87 girls with T2D included in these studies, the pooled prevalence of PCOS was 24.04% (95% CI, 15.07%, 33.01%). There were 2 studies in which the prevalence of PCOS by race was reported; reported prevalence was 17% among 36 white females, 23.10% in Indian adolescent females (N = 195), and 2.0% in indigenous females in Canada (N = 64).The authors conclude that approximately 1 in 5 girls with T2D had PCOS.Dr. Fechner has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.It is not surprising that 1 in 5 girls with T2D have PCOS, as insulin resistance with hyperinsulinemia increases androgen production by the ovary, leading to PCOS.1 While the diagnosis of PCOS in adult women requires 2 of 3 criteria: androgen excess, oligo/anovulation or polycystic ovaries,2 the presence of polycystic ovaries on ultrasound and anovulatory symptoms may be normal in the early post-menarchal years. Thus, a history of anovulation and an ultrasound with polycystic ovaries may be normal during the period after menarche. A consensus statement on the pathophysiology, diagnosis, and treatment of PCOS in adolescence in 2017 suggested the diagnostic criteria of clinical and/or biochemical hyperandrogenism with irregular menses/oligomenorrhea at least 2 years post-menarche.3As in adults, it is important to exclude other etiologies such as non-classic congenital adrenal hyperplasia, hyperprolactinemia, and thyroid disease. PCOS has many of the same co-morbidities as T2D. In addition, there is increased infertility and increased risk of endometrial cancer as well as possible increased androgen exposure to the female fetus leading to ambiguous genitalia in the fetus.2 Treatment of PCOS overlaps T2D treatment, with lifestyle management to lose weight as a primary intervention. Adolescents with PCOS may also benefit from the use of an oral contraceptive to decrease androgens and improve acne, hirsutism, anovulatory symptoms, and to prevent pregnancy. Metformin for those unsuccessful with lifestyle management may also benefit both PCOS and T2D management.3It is important to gather menstrual history and look for signs of hyperandrogenism in females with T2D as PCOS appears to be a relatively common morbidity in girls with T2D.