Diabetes: a metabolic and reproductive disorder in women

Thong, Eleanor P.; Codner, Ethel; Laven, Joop; Teede, Helena

doi:10.1016/s2213-8587(19)30345-6

Cited by 143 publications

(133 citation statements)

References 149 publications

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“…The same argument could apply to PCOS secondary to other drivers of hyperinsulinemia such as type 1 diabetes. We could elude to an emerging concept of PCOS secondary to other drivers of hyperinsulinaemia and hyperandrogenism such as obesity and type 1 diabetes [4,87]. Vitally important was the emphasis on lifestyle interventions to prevent excess weight gain in adolescents with PCOS, avoiding waiting until obesity has developed, where lifestyle intervention alone is unlikely to reverse the excess adiposity.…”

Section: Treatment Lifestylementioning

confidence: 99%

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Peña

Witchel

Hoeger

et al. 2020

BMC Med

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180

232

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Background: Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. Methods: International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. Results: This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years postmenarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years postmenarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. Conclusions: Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.

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Section: Treatment Lifestylementioning

confidence: 99%

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Peña

Witchel

Hoeger

et al. 2020

BMC Med

Self Cite

180

232

View full text Add to dashboard Cite

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“…Type 2 diabetes is associated with metabolic traits like polycystic ovary syndrome, obesity, insulin resistance and chronic inflammation. In general, both type 1 and type 2 diabetes are associated with a number of reproductive problems including reduced fertility, early and late pregnancy loss, congenital malformations, vascular stress, hypertensive disorders in pregnancy, preterm labour and infections [8][9][10][11][12][13][14]. These conditions are more prevalent in obese women compared with normalweight women even in the absence of diabetes [15,16].…”

Section: Introductionmentioning

confidence: 99%

Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study

et al. 2020

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Aims/hypothesis Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. Methods This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. Results Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. Conclusions/interpretation Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women.

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“…However, alteration of the uterus functionality in female diabetic patients is an under-investigated complication [ 41 , 42 , 43 , 44 ]. The intensification of insulin therapy and the improvement of metabolic control ameliorate menstrual and reproductive disorders, although they do persist [ 18 , 45 ]. Despite improvements in diabetes therapy patients still face abnormalities in their pubertal development, menstrual cycles, fertility, and age of menopause, with hyperandrogenism and oligomenorrhoea being the most prevalent problems in young adult DM patients.…”

Section: Discussionmentioning

confidence: 99%

“…With the onset of T1DM menstrual cycle disturbance, subfertility, earlier menopause, as well as pregnancy complications have been described [ 18 , 19 , 20 , 21 ]. T1DM is thought to disrupt the physiological morphology of the myometrium and then the normal uterus functionality [ 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Uterine Dysfunction in Diabetic Mice: The Role of Hydrogen Sulfide

et al. 2020

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It is well-known that the physiological uterine peristalsis, related to several phases of reproductive functions, plays a pivotal role in fertility and female reproductive health. Here, we have addressed the role of hydrogen sulfide (H2S) signaling in changes of uterine contractions driven by diabetes in non-obese diabetic (NOD) mice, a murine model of type-1 diabetes mellitus. The isolated uterus of NOD mice showed a significant reduction in spontaneous motility coupled to a generalized hypo-contractility to uterotonic agents. The levels of cyclic nucleotides, cAMP and cGMP, notoriously involved in the regulation of uterus homeostasis, were significantly elevated in NOD mouse uteri. This increase was well-correlated with the higher levels of H2S, a non-specific endogenous inhibitor of phosphodiesterases. The exposure of isolated uterus to L-cysteine (L-Cys), but not to sodium hydrogen sulfide, the exogenous source of H2S, showed a weak tocolytic effect in the uterus of NOD mice. Western blot analysis revealed a reorganization of the enzymatic expression with an upregulation of 3-mercaptopyruvate-sulfurtransferase (3-MST) coupled to a reduction in both cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE) expression. In conclusion, the increased levels of cyclic nucleotides dysregulate the uterus peristalsis and contractility in diabetic mice through an increase in basal H2S synthesis suggesting a role of 3-MST.

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Diabetes: a metabolic and reproductive disorder in women

Cited by 143 publications

References 149 publications

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study

Uterine Dysfunction in Diabetic Mice: The Role of Hydrogen Sulfide

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