DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20191544

Prevalence of glucose abnormalities in polycystic ovary syndrome women and evaluating the efficacy of fasting blood glucose in detecting these glucose abnormalities compared to glucose tolerance test

Swarnalatha Mohanapu, Abinaya Maathuri Jayakumar

Abstract


Background: Polycystic ovarian syndrome (PCOS) is the most commonly prevalent endocrinopathy of reproductive age women. It is a significant public health issue with reproductive, metabolic and psychological features. Because patients with PCOS are at high risk for developing glucose abnormalities, the early identification of affected patients and institution of life style changes or pharmacological treatment may help reduce the long-term risks associated with PCOS. This study was done to assess the prevalence of glucose abnormalities and to evaluate the efficacy of Fasting blood glucose (FBG) in detecting glucose abnormalities when compared to 2 hrs oral glucose tolerance test (OGTT).

Methods: Hospital based cross sectional study carried out in 300 women diagnosed as PCOS according to Rotterdam criteria. In patients diagnosed as PCOS, Fasting Blood Glucose and OGTT were done. OGTT taken as an accurate test and FBG values compared with OGTT values to evaluate the efficacy of FBG. Prevalence of glucose abnormalities and association with age, BMI and clinical features was evaluated.

Results: Glucose abnormalities were detected in 69 (23%) women with 2 hours OGTT, but with FBG only in 49 (16.33%) women, around one third of women were missed. Sensitivity of FBG was 71.01% (95% CI 58.84% to 81.31%). Mean age of women with abnormal OGTT (27.99) was significantly higher than the women with normal OGTT (24.7). Mean BMI of women with abnormal OGTT (27.42) was significantly higher than the Mean BMI of women with normal OGTT (23.36).

Conclusions: Sensitivity of FBG was low in detecting glucose abnormalities. Increasing age, increase in a BMI, menstrual abnormalities, hirsutism/acne and family history of diabetes appear to have positive linear correlation with prevalence of glucose abnormalities.


Keywords


Fasting blood glucose, Glucose abnormalities, OGTT, PCOS

Full Text:

PDF

References


Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Human Repro Update. 2006;12(6):673-83.

Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(4):1929-35.

Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84(1):165-9.

Deeks AA, Gibson-Helm ME, Paul E, Teede HJ. Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression?. Human Repro. 2011;26(6):1399-407.

Tominaga M, Eguchi HI, Manaka HI, Igarashi K, Kato TA, Sekikawa AK. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. Funagata Diab Study. Diab Care. 1999;22(6):920-4.

Eshre TR. ASRM-sponsored PCOS consensus workshop group. revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility Sterility. 2004;81(1):19-25.

Ferriman DA, Purdie AW. The aetiology of oligomenorrhoea and/or hirsuties: a study of 467 patients. Postgrad Med J. 1983;59(687):17-20.

Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. JAPI. 2009;57(2):163-70.

American Diabetes Association. Standards of medical care in diabetes. Diab Care. 2015;38(1):S1-93.

Kenny SJ, Aubert RE, Geiss LS. Prevalence and incidence of NIDDM. In: Harris MI, eds. Diabetes in America. Washington DC: US National Institutes of Health, NIH publication;1995:179-220.

Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound Insulin resistance, independent of obesity in PCOS. Diab. 1989;38:1165-74.

Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diab. 1992;41(10):1257-66.

Ek I, Arner P, Bergqvist A, Carlstrom K, Wahrenberg H. Impaired adipocyte lipolysis in nonobese women with polycystic ovary syndrome: a possiblelink to insulin resistance? J Clin Endocrinol Metab. 1997;82:1147-53.

Rosenbaum D, Haber RS, Dunaif A. Insulin resistance in polycystic ovary syndrome: decreased expression of GLUT-4 glucose transporters in adipocytes. Am J Physio. 1993;264(2): E197-E202.

Nestler JE, Jakubouuicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999;340:1314-20.

Dunaif A, Finegood DT. Beta cell dysfunction independent of obesity and glucose intolerance in polycystic ovary syndrome. J Clin Endocrinol Metab. 1996;81:942-7.

Ganie MA, Khurana ML, Eunice M, Guptha M, Dwivedi S, Gulati M, et al. Prevalence of glucose intolerance among adolescents and young women with PCOS in India. Ind J Clin Endocrinol Metab. 2004:6:9-14.

Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 DM and metabolic syndrome. A systematic review and metaanalysis. Hum Reprod Update. 2010:16(4):347-63.

Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 DM and IGT in PCOS. A prospective controlled study in 254 affected women. J Clin Endocrinol Metab. 1999:84:165-9.

Rubin KH, Glintborg D, Nybo M, Abrahamsen B, Andersen M. Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(10):3848-57.

Pelanis R. The prevalence of Type 2 DM is not increased in normal weight women with PCOS. Human reproduction (Oxford, England), 2017.32(11):1-8.

Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Guideline Development Groups. Assessment and management of polycystic ovary syndrome: summary of an evidenceā€based guideline. Med J Aus. 2011;195:S65-112.

Kakoly NS. Ethnicity, obesity and prevalence of IGT and Type 2 DM in PCOS: a systamatic review and meta regression. Human Repro Update. 2018. Available at: https://academic.oup.com/humupd/article-abstract/24/4/455/4953995?redirectedFrom=fulltext

Trolle B, Lauszus FF. Risk factors for glucose intolerance in Danish women with PCOS. Acta Obstet Gynecol Scand. 2005;84:1192-6.

Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK. Imperial J Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diab Care. 1999;22:141-6.

Burghan GA, Givens JR, Kitabachi AE. Corelation of hyperandrogenism with hyper insulinism in PCOD. J Clin Endocrinol Metab. 1980:50:113-6.

Norman RJ, Mahabeer S, Masters S. Ethnic differences in insulin and glucose response to glucose between white and Indian women in polycystic ovary syndrome. Fertil Steril. 1995;63:58-62.

World Health Organisation 2006 definition and diagnosis of Diabetes Mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: WHO. Available at: https://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/

American Diabetes Association. Standards of medical care in diabetes-2007. Diab Care. 2007;30(1):S4-1.

Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obs Gynecol Survey. 2004;59(2):141-54.

Tomlinson J, Millward A, Stenhouse E, Pinkney J. Type 2 diabetes and cardiovascular disease in polycystic ovary syndrome: what are the risks and can they be reduced?. Diab Med. 2010;27(5):498-515.

Lau DC. Screening for diabetes in women with polycystic ovary syndrome. CMAJ. 2007;176(7):951-2.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Eng J Med. 2002;346(6):393-403.

American Diabetes Association. Standards of medical care in diabetes-2017. Diab Care. 2017;40(1).

Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab. 2005 Jun 1;90(6):3236-42.