Abstract
Background The nature of the independent relationship between polycystic ovary syndrome (PCOS) and type 2 diabetes (DM2) remains unclear. Few studies have aimed to clarify this relationship independent of obesity, in longitudinal population-based cohorts. Methods We undertook a retrospective cohort study of women aged 18-23 over 15 years (2000-2015), surveyed three-yearly, from the ongoing Australian Longitudinal Study on Women's Health (ALSWH). We undertook survival analysis using Cox Proportional Hazard Model to identify predictors of DM2 and person-time analysis to calculate incidence rates of DM2/1000 person-years (PY). Findings During a follow-up of 1,919 years of person-time, 186 women developed DM2. The incidence rates were 4·19/1000 and 1·02/1000 PY (p<0.001) in PCOS and controls. On sub-group analyses by body mass index (BMI) categories across healthy-weight, overweight, and obese women, the incidence rate-ratios for DM2 were 4·68, 3·52, and 2·36 (p<0·005) in cases vs. controls. In multivariate Cox regression for the entire cohort, PCOS was one of the most influential predictors for DM2 (HR: 3·23, 95% CI: 2·07, 5·05, p<0·001) adjusting for BMI, education, area of residence, and family history of DM2. Interpretation Women with PCOS are at an increased risk of DM2, irrespective of age and BMI. Based on the moderate level of absolute clinical risk demonstrated here, guideline recommendations should consider DM2 screening at least three-yearly in all women with PCOS, across BMI categories and age ranges, influenced by local resources and patient preference. Funding Monash International Post-graduate Research Scholarship, NHMRC-Early Career Fellowship, and NHFA-Future Leader Fellowship support NSK, HJT, LJM, and AEJ. Conflict of Interests: No authors have any conflict of interest. Ethical Approval Statement: The Human Research Ethics Committees of the University of Newcastle and the University of Queensland approved the study methods.
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