The potential of survivin as a non-invasive diagnostic marker for endometriosis in patients with type 1 diabetes mellitus

Abstract

BACKGROUND: According to international data, about 5-10% of women of reproductive age suffer from this disease, while in women with chronic pelvic pain or infertility the incidence ranges from 35% to 50%. At the same time, women of reproductive age diagnosed with diabetes mellitus type 1 may also suffer from endometriosis, but asymptomatic or atypical in the initial stages of the disease, which varies considerably in duration, may be the cause of untimely diagnosis. Existing diagnostic methods in the form of bimanual examination, ultrasound, MRI, laparoscopic surgery, and even histologic verification do not allow to exclude with certainty the presence of the disease.
 AIM: The aim of this study was to investigate the prevalence and characteristics of endometriosis among patients with type 1 diabetes mellitus to develop a diagnostic prognostic model.
 MATERIALS AND METHODS: We carried out a retrospective analysis of medical records from the Gynecological Unit of the Second Department of Gynecology and Endocrinology and the Scientific Advisory Department of D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, St. Petersburg, Russia for the period of 2010–2021. The study cohort included cases of endometriosis in patients with type 1 diabetes mellitus recorded in inpatient or outpatient medical histories. Clinical characteristics of the prevalence of endometriosis in women with type 1 diabetes mellitus were based on an analysis of 2316 medical records in this patient group. The prospective cohort of the case-control study included 137 patients and involved the evaluation of survivin levels in serum on days 5–7 of the menstrual cycle in four study groups: type 1 diabetes mellitus in combination with endometriosis, endometriosis, type 1 diabetes mellitus, and healthy women of reproductive age. Additionally, we examined the gynecological history of patients. Statistical processing of the data obtained and predictive modeling were performed using a binary logistic regression analysis.
 RESULTS: The prevalence of endometriosis among patients with type 1 diabetes mellitus was 1.11%. Risk indicators for the presence of endometriosis were determined based on risk factor values for patients with or without type 1 diabetes mellitus. Patient groups with a probability of having endometriosis exceeding 50% were identified, requiring diagnostic and therapeutic measures aimed at timely initiation of therapy.
 CONCLUSIONS: Predicting the likelihood of endometriosis presence will enable timely preventive and therapeutic measures aimed at improving the patient’s quality of life.