Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen, Marianne; Glintborg, Dorte

doi:10.1530/eje-18-0237

Cited by 32 publications

(32 citation statements)

References 102 publications

(159 reference statements)

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“…PCOS is a stronger risk factor for stroke than a family history of CVD (odds ratio: 1.38, 95% CI 1.01 to 1.88) ( Valerio et al , 2016 ). Given the increase in cardiometabolic risk, it is understandable that cardiometabolic screening of women with PCOS is regularly suggested in international guidelines ( Huang and Coviello, 2012 ; Andersen and Glintborg, 2018 ). However, it is important to consider that increased risk alone does not justify screening ( Andermann et al , 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis

Wekker

Dammen

Koning

et al. 2020

Human Reproduction Update

215

127

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BACKGROUND Polycystic ovary syndrome (PCOS) is associated with cardiometabolic disease, but recent systematic reviews and meta-analyses of longitudinal studies that quantify these associations are lacking. OBJECTIVE AND RATIONALE Is PCOS a risk factor for cardiometabolic disease? SEARCH METHODS We searched from inception to September 2019 in MEDLINE and EMBASE using controlled terms (e.g. MESH) and text words for PCOS and cardiometabolic outcomes, including cardiovascular disease (CVD), stroke, myocardial infarction, hypertension (HT), type 2 diabetes (T2D), metabolic syndrome and dyslipidaemia. Cohort studies and case–control studies comparing the prevalence of T2D, HT, fatal or non-fatal CVD and/or lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) between women with and without PCOS of ≥18 years of age were eligible for this systematic review and meta-analysis. Studies were eligible regardless of the degree to which they adjusted for confounders including obesity. Articles had to be written in English, German or Dutch. Intervention studies, animal studies, conference abstracts, studies with a follow-up duration less than 3 years and studies with less than 10 PCOS cases were excluded. Study selection, quality assessment (Newcastle–Ottawa Scale) and data extraction were performed by two independent researchers. OUTCOMES Of the 5971 identified records, 23 cohort studies were included in the current systematic review. Women with PCOS had increased risks of HT (risk ratio (RR): 1.75, 95% CI 1.42 to 2.15), T2D (RR: 3.00, 95% CI 2.56 to 3.51), a higher serum concentration of TC (mean difference (MD): 7.14 95% CI 1.58 to 12.70 mg/dl), a lower serum concentration of HDL-C (MD: −2.45 95% CI −4.51 to −0.38 mg/dl) and increased risks of non-fatal cerebrovascular disease events (RR: 1.41, 95% CI 1.02 to 1.94) compared to women without PCOS. No differences were found for LDL-C (MD: 3.32 95% CI −4.11 to 10.75 mg/dl), TG (MD 18.53 95% CI −0.58 to 37.64 mg/dl) or coronary disease events (RR: 1.78, 95% CI 0.99 to 3.23). No meta-analyses could be performed for fatal CVD events due to the paucity of mortality data. WIDER IMPLICATIONS Women with PCOS are at increased risk of cardiometabolic disease. This review quantifies this risk, which is important for clinicians to inform patients and to take into account in the cardiovascular risk assessment of women with PCOS. Future clinical trials are needed to assess the ability of cardiometabolic screening and management in women with PCOS to reduce future CVD morbidity.

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Section: Discussionmentioning

confidence: 99%

Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis

Wekker

Dammen

Koning

et al. 2020

Human Reproduction Update

215

127

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“…Compared to the FPG and A1c tests, numerous investigations show that the OGTT is the best single measure for predicting subsequent diabetes, disease, and/or mortality [ 17 , 18 , 19 , 20 , 21 ]. Although more time-consuming and difficult to administer for the diagnosis of diabetes, the OGTT is considered by many to be the gold standard [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Consequently, in the present study, the OGTT was used as the referent in each comparison.…”

Section: Discussionmentioning

confidence: 99%

Limited Agreement between Classifications of Diabetes and Prediabetes Resulting from the OGTT, Hemoglobin A1c, and Fasting Glucose Tests in 7412 U.S. Adults

Tucker

2020

JCM

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This investigation was designed to determine the degree of concordance resulting from tests of fasting plasma glucose (FPG) and hemoglobin A1c (A1c) compared to the oral glucose tolerance test (OGTT) for detecting prediabetes and diabetes in undiagnosed adults. Another objective was to measure concordance within subsamples of women and men, and within three age groups. Lastly, the value of combining the FPG and A1c for detecting diabetes was compared to the OGTT. A total of 7412 randomly selected adults from the National Health and Nutrition Examination Survey (NHANES) were included. With outcomes classified as normal, prediabetes, or diabetes, according to standard guidelines, overall test agreements were low. With an OGTT diagnosis of diabetes, concordance was only 34% for the A1c assessment and 44% for the FPG assay. Delimited to older adults, agreement between the OGTT and A1c was only 25%, and between the OGTT and FPG, concordance was only 33.5%. Given the large percentage of discordant results associated with the FPG and A1c, clinicians should be cautious about employing these tests as lone assessments. Using both the FPG and A1c helped with accurately diagnosing diabetes and normal glycemia, but not prediabetes. The OGTT is a good choice to reduce misdiagnosis.

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“…Although there remains uncertainty about the role of HbA1c in women with PCOS, to test for prediabetes and T2DM, the ADA stated that FPG, 75g OGTT and HbA1c are equally appropriate, including women with PCOS 18 . Furthermore, some studies suggested that in women with PCOS, HbA1c might be a good indicator or may be applied instead of OGTT in most instances 26,27 . Thus, our study has the merit of using both HbA1c and OGTT.…”

Section: Discussionmentioning

confidence: 92%

Progression to prediabetes or diabetes in young Korean women with polycystic ovary syndrome: A longitudinal observational study

Choi

Hwang

et al. 2021

Clinical Endocrinology

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Objective To investigate changes in glycaemic status in women with polycystic ovary syndrome (PCOS). Design Longitudinal observational study. Patients Women with PCOS who underwent baseline and follow‐up screening tests for diabetes (n = 262). Four patients with type 2 diabetes (T2DM) at baseline and 6 patients who were taking drugs at the final follow‐up were excluded. Measurements Changes in glycaemic classification based on fasting glucose, haemoglobin A1c and oral glucose tolerance test. Results The median length of follow‐up was 2.9 years. The mean age and body mass index in the normoglycaemia group (n = 202) were 23.0 years and 21.6 kg/m2, while it was 23.6 years and 22.9 kg/m2 in the prediabetes group (n = 50). In the normoglycaemia group, 38 (18.8%) and 2 (1.0%) developed prediabetes and T2DM, respectively. In the prediabetes group, 22 (44.0%) remained in the same category, 6 (12.0%) developed T2DM, while 22 (44.0%) achieved normoglycaemia. The incidence rate of T2DM was 9.3 per 1,000 person‐years, which was significantly higher than that of the female population of similar age, and the incidence was higher in women with fasting glucose ≥ 5.6 mmol/L at baseline than in women with < 5.6 mmol/L. Conclusions About 20% of normoglycaemic women had developed prediabetes or T2DM after a median time of 2.9 years. Meanwhile, nearly half of prediabetes women achieved normoglycaemia. Higher baseline fasting glucose levels were associated with an increased incidence of T2DM. Our results are the first to evaluate glycaemic status changes using all three parameters in patients with PCOS.

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Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Cited by 32 publications

References 102 publications

Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis

Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis

Limited Agreement between Classifications of Diabetes and Prediabetes Resulting from the OGTT, Hemoglobin A1c, and Fasting Glucose Tests in 7412 U.S. Adults

Progression to prediabetes or diabetes in young Korean women with polycystic ovary syndrome: A longitudinal observational study

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