Prevalence of abnormalities of glucose metabolism in patients with polycystic ovary syndrome

Abstract

Patients with polycystic ovary syndrome (PCOS) present a higher risk for abnormalities of glucose metabolism (AGM). For to study this in our population, we submitted 85 patients, with body mass index (BMI) of 28.5 ± 6.6 kg/m 2 and aged 25.5 ± 5.4 years old, to an oral glucose tolerance test (OGTT), and assessed the impact of BMI on the prevalence of impaired glucose tolerance (IGT) and of diabetes mellitus (DM). The states of glucose tolerance were classified considering fasting plasma glucose (FPG) according to the American Diabetes Association (ADA) criterion and plasma glucose at 120 minutes according to the Word Health Organization (WHO) criterion. According to the ADA criteria, 83.5% classified as normal and 16.5% as with AGM, with 15.3% presenting impaired fasting glucose and 1.2% DM, while according to the WHO criteria, 68.2% were classified as normal and 31.8% as with AGM, with 27.0% of them presenting IGT and 4.8% DM. Seventy-three percent of PCOS patients with IGT by WHO criterion had normal FPG by ADA criterion. The prevalence of AGM for both criteria increased with the body mass index. In conclusion, we found a higher prevalence of AGM in PCOS patients than that found in the general population, being the highest in obese patients. Glycemia at 120 minutes on the OGTT identified more patients with AGM than fasting glycemia. We recommended that the assessment of AGM must be done by the OGTT in all patients with PCOS. RESUMO Prevalência de Anormalidades do Metabolismo de Glicose em Pacientes com a Síndrome dos Ovários Policísticos.Pacientes com a síndrome dos ovários policísticos (SOP) têm um risco maior para desenvolver anormalidades do metabolismo da glicose (AMG). Para avaliarmos a prevalência dessas anormalidades na nossa população, submetemos 85 pacientes, com índice de massa corporal (IMC) de 28,5 ± 6,6 kg/m 2 e média etária de 25,5 ± 5,4 anos, a teste de tolerância oral à glicose (TTOG). Os estados de tolerância à glicose foram classificados considerando a glicemia de jejum (GJ; American Diabetes Association -ADA) e glicemia aos 120 minutos (G120; Organização Mundial de Saúde -OMS). De acordo com a ADA, 83,5% das pacientes foram normais e 16,5% com AMG, com 15,3% apresentando glicemia de jejum imprópria e 1,2% diabetes mellitus (DM). De acordo com a OMS, 68,2% foram normais e 31,8% com AMG, com 27,0% apresentando intolerância à glicose (IG) e 4,8% DM. Observamos que 73% das pacientes com IG pelos critérios da OMS apresentavam GJ normal pelos critérios da ADA. A prevalência de AMG para ambos os critérios foi maior entre as pacientes com IMC mais elevado. Conclusão: encontramos maior prevalência de AMG nas pacientes com a SOP do que na população geral, sendo mais elevada entre as pacientes obesas. Além disso, a G120 no TTOG identificou maior número de pacientes com AMG do que a GJ. Assim, recomendamos avaliação de AMG através do TTOG para todas as pacientes portadoras da SOP.

Obesity, but not polycystic ovary syndrome, affects circulating markers of low-grade inflammation in young women without major cardiovascular risk factors

“…43 Moreover, it is established that the effect of TNF-α, through activation of the soluble receptors TNFR1 and sTNFR2, is related to components of the metabolic syndrome, 18 such as IGT and type 2 DM(19), higher blood pressure 20 and dyslipidemia, 23 which are common in women with PCOS, even in those with normal BMI. 42,44 As for the inflammatory molecules, data on the relationship between PCOS and carotid intima-media wall thickness (cIMT), a marker of preclinical atherosclerosis, are not conclusive. In a previous study, 25 in this same cohort of women, we have demonstrated that by adopting stricter diagnostic criteria and excluding major CV risk factors 25,45 no differences were evident in vascular parameters related to early atherosclerosis in women with PCOS.…”

Metabolic Disturbance in PCOS: Clinical and Molecular Effects on Skeletal Muscle Tissue

“…That is, the prevalence of intolerance to carbohydrate was progressively higher with the increasing BMI, regardless of diagnostic criteria employed. One of the conclusions of this study was that all PCOS patients should be tested with oral glucose tolerance, since this method was more sensitive than FG in the detection of IR [28]. …”

A importância do teste de tolerância à glicose oral no diagnóstico da intolerância à glicose e diabetes mellitus do tipo 2 em mulheres com síndrome dos ovários policísticos

“…Estes dados são consistentes com estudos prévios que mostram a necessidade de realização do TTGO em mulheres com SOP 2,5, 18,19 , e demonstram que a glicemia de jejum subdiagnóstica e é relativamente insensível na SOP, pois as pacientes com SOP e IG podem apresentar glicemia de jejum normal 2,8 .…”

“…Porém, são inferiores à descrita em um grupo de pacientes com SOP obesas que apresentaram 30,5% de IG e 13,3% de DM-2 versus SOP não obesas (12,2x4,4%) de Ribeirão Preto -(SP) 23 , mas comparáveis à frequência de DM-2 (4,8%) em mulheres com SOP na cidade de São Paulo 18 , e também as verificadas em pacientes australianas com SOP (15,6% IG e 4,0% de DM-2) 3 .…”