Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis

Abstract

BACKGROUND Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women associated with impaired glucose tolerance (IGT), type 2 diabetes mellitus (DM2) and the metabolic syndrome. METHODS A literature search was conducted (MEDLINE, CINAHL, EMBASE, clinical trial registries and hand-searching) identifying studies reporting prevalence or incidence of IGT, DM2 or metabolic syndrome in women with and without PCOS. Data were presented as odds ratio (OR) [95% confidence interval (CI)] with fixed- and random-effects meta-analysis by Mantel-Haenszel methods. Quality testing was based on Newcastle-Ottawa Scaling and The Cochrane Collaboration's risk of bias assessment tool. Literature searching, data abstraction and quality appraisal were performed by two investigators. RESULTS A total of 2192 studies were reviewed and 35 were selected for final analysis. Women with PCOS had increased prevalence of IGT (OR 2.48, 95% CI 1.63, 3.77; BMI-matched studies OR 2.54, 95% CI 1.44, 4.47), DM2 (OR 4.43, 95% CI 4.06, 4.82; BMI-matched studies OR 4.00, 95% CI 1.97, 8.10) and metabolic syndrome (OR 2.88, 95% CI 2.40, 3.45; BMI-matched studies OR 2.20, 95% CI 1.36, 3.56). One study assessed IGT/DM2 incidence and reported no significant differences in DM2 incidence (OR 2.07, 95% CI 0.68, 6.30). One study assessed conversion from normal glucose tolerance to IGT/DM2 (OR 2.4, 95% CI 0.7, 8.0). No studies reported metabolic syndrome incidence. CONCLUSIONS Women with PCOS had an elevated prevalence of IGT, DM2 and metabolic syndrome in both BMI and non-BMI-matched studies. Few studies have determined IGT/DM2 or metabolic syndrome incidence in women with and without PCOS and further research is required.

European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire

“…(5,6). The different prevalence of obesity in the clinical series of women with PCOS almost certainly reflects the overall rates of obesity (30-70%) in different populations (24,25,26).…”

“…In adult overweight or obese PCOS women, menstrual abnormalities and chronic oligo-anovulation are more frequent, and the degree of hyperandrogenemia tends to be worse than in normal-weight women (29). It is of importance that longitudinal studies have shown that insulin resistance may worsen over time in obese PCOS women (30), and obesity per se is the major risk factor for the early development of T2D (5,6).…”

“…In addition, women with PCOS are characterized by an increased susceptibility to develop glucose intolerance and type 2 diabetes (T2D) (5,6). These metabolic disorders are particularly common in women with the classic hyperandrogenic-anovulatory phenotype (7,8).…”

Maternal and fetal insulin levels at birth in women with polycystic ovary syndrome: data from a randomized controlled study on metformin

“…PCOS is characterized by polycystic ovaries, oligoamenorrhea, and hyperandrogenism. It is associated with maternal obesity (3), insulin resistance (4), metabolic syndrome and type II diabetes (5,6), dyslipidemia (4), endometrial cancer, and possibly cardiovascular diseases later in life (4). Increased prevalence of pregnancy complications and adverse pregnancy outcomes is reported in PCOS women (7).…”

MECHANISMS IN ENDOCRINOLOGY: Proteomic biomarkers of type 2 diabetes mellitus risk in women with polycystic ovary syndrome

“…A recent systematic review and meta-analysis showed that women with PCOS were four times more likely to develop T2DM compared with BMI-matched controls (10). Insulin resistance is proposed as a key pathophysiological feature of PCOS contributing to reproductive, cardiovascular and metabolic disturbances.…”