Assessment of Insulin Resistance and Impaired Glucose Tolerance in Lean Women with Polycystic Ovary Syndrome

Abstract

Objective: To analyze insulin resistance (IR) and determine the need for a 2-hour oral glucose tolerance test (OGTT) for the identification of IR and impaired glucose tolerance (IGT) in lean nondiabetic women with polycystic ovary syndrome (PCOS). Methods: This was a cross-sectional analysis of treatment-naive women with PCOS who enrolled in a universitybased clinical trial. Nondiabetic women with PCOS based on the Eunice Kennedy Shriven National Institute of Child Health and Human Development (NICHD) definition, aged 18-43 years and weighing 113 kg, were evaluated. Glucose and insulin levels were assessed at times 0, 30, 60, 90, and 120 minutes after a 75-g glucose load. Lean was defined as body mass index (BMI) <25 kg=m 2 . Multiple linear regression was performed. Results: A cohort of 78 women was studied. The prevalence of IR was 0% among lean women vs. 21% among nonlean subjects based on fasting insulin I 0 and 40%-68% based on two different homeostatic model assessment (HOMA) cutoff points ( p < 0.005). All women with IR had a BMI ! 28. Controlling for age and race, BMI explained over 57% of the variation in insulin fasting (I o ), glucose fasting=Io (G o =I o ), the qualitative insulin sensitivity check index (QUICKI), and HOMA and was a highly significant predictor of these outcomes ( p < 0.0001). Only 1 of 31 (3%) of the lean PCOS women had IGT based on a 2-hour OGTT, and no lean subjects had IGT based on their fasting blood glucose. Conclusions: Diabetes mellitus, IGT, and IR are far less common in young lean women with PCOS compared with obese women with PCOS. These data imply that it is unnecessary to routinely perform either IR testing or 2-hour OGTT in lean women with PCOS; however, greater subject accumulation is needed to determine if OGTT is necessary in lean women with PCOS. BMI is highly predictive of both insulin and glucose levels in women with PCOS.

Diverse impacts of aging on insulin resistance in lean and obese women with polycystic ovary syndrome: evidence from 1345 women with the syndrome

“…confirmed by other research groups (33,34,35). Besides, it has been shown that women with PCOS display a strong positive family history of DM, another fundamental predisposing factor in DM development (36).…”

The pathogenesis and treatment of polycystic ovary syndrome: What’s new?

“…Patients diagnosed with PCOS are included in the groups at risk of developing diabetes, in accordance with the standards of the Polish Diabetes Association. 14 …”

Comparison of Insulin Sensitivity Levels in Women with PCOS and Women with Regular Menses

“…Bu metabolik yüke bir de vücut yağ kitlesi fazlalığı olarak bilinen obezitenin eklenmesi bu sendromdan etkilenen kadınların glukoz metabolizmasının daha da fazla bozulmasına yol açar. Hatta zayıf PKOS'lu kadınlardaki insülin duyarlılığındaki azalma seviyesinin PKOS'u olmayan obes kadınlarakine benzer derecede olduğu bildirilmiştir [11][12][13] . Androjen fazlalığı cemiyeti obez PKOS'luların zayıf PKOS'lulara kıyasla tip 2 diabetes mellitus gelişim riskinin daha fazla olmasından ötürü obes PKOS'lularda olası bozulmuş glukoz toleransı veya tip 2 diabetes mellitus varlığının incelenmesi amacı ile 2 saatlik glukoz yükleme testinin rutin olarak uygulanmasını önermektedir 14 .…”