Polycystic ovary syndrome in adolescence: impaired glucose tolerance occurs across the spectrum of BMI

Abstract

Context Polycystic ovary syndrome (PCOS) is a chronic condition with metabolic manifestations spanning the reproductive years. Objective We sought to examine glucose metabolism, irrespective of the presence of obesity in a cohort of adolescent girls with PCOS. Design One hundred adolescents were assessed for PCOS in a multi-specialty adolescent PCOS program. PCOS was diagnosed by Androgen Excess Society criteria. Oral glucose tolerance testing (OGTT), homeostatic model assessment of insulin resistance, and androgen and lipid profiles were performed for those meeting criteria. Results Sixty-six adolescents (mean age 15.8 ± 0.2 yrs, range 13.0–18.6) had confirmed PCOS, and were eligible for inclusion in our analysis. Abnormal glucose metabolism was present in 12 of 66 (18.2%) subjects: 2 (3.0%) impaired fasting glucose, 10 (15.2%) impaired glucose tolerance (IGT), and 1 (1.5%) type 2 diabetes. IGT was the most common abnormality, occurring with equal frequency in obese (OB, mean body mass index (BMI) 36.9 ± 0.8 kg/m2) and non-obese (NOB, mean BMI 24.5 ± 0.6 kg/m2) adolescents (p = 0.3). In a subgroup analysis, NOB adolescents with IGT (NOB-IGT) had similar mean 2-h insulin, high density lipoprotein, C-reactive protein, and testosterone levels to the OB cohort despite marked differences in BMI (p < 0.001) and % body fat (p = 0.002). However, the NOB-IGT group had a lower mean fasting insulin level than the OB cohort (p = 0.04). Conclusion Abnormal glucose metabolism is highly prevalent in adolescents with PCOS. In particular, IGT occurs across the spectrum of BMI. A screening OGTT should be considered for adolescents diagnosed with PCOS, independently of their BMI.

Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis

“…We included dysglycemia as a composite outcome to answer the growing clinical concern that OCPs lead to disturbances in glucose metabolism and increased risk of prediabetes and T2DM in a population that already has an increased baseline risk for prediabetes and T2DM. [12][13][14]31 The search terms used included combinations of subject headings and keywords with various synonyms for PCOS, adolescent, metformin, pioglitazone, OCP, flutamide, and lifestyle interventions (Supplemental Information). We used the RCT filter created from McMaster University for Ovid Embase platform, and the Cochrane library filter for Ovid Medline platform.…”

“…[5][6][7][8] Insulin resistance plays a major role in the development of the cardiometabolic disturbances associated with PCOS such as dysglycemia, hyperlipidemia, and obesity. [9][10][11] In adolescents with PCOS, 18% to 24% have abnormal glucose metabolism (3% to 4% impaired fasting glucose, 13% to 15.2% impaired glucose tolerance, and 1.5% type 2 diabetes [T2DM] [12][13][14]. These metabolic disturbances are associated with an increased prevalence of T2DM, myocardial infarction, infertility, gestational diabetes, premature delivery, and risk for gynecologic cancers.…”

Metabolic Issues in Adolescence

“…Adolescent girls with PCOS have significantly higher rates of perturbations of glucose metabolism, mainly IGT [89][90][91], and are at increased risk of hypertension [92] and MS [89,93], compared to their healthy counterparts. IR and metabolic perturbations are more prevalent in obese than in non obese girls with PCOS [89,91,92] and increased androgens in obese girls with PCOS have been associated with increased cIMT [28].…”

“…IR and metabolic perturbations are more prevalent in obese than in non obese girls with PCOS [89,91,92] and increased androgens in obese girls with PCOS have been associated with increased cIMT [28]. Longitudinally, PCOS at 14 years has been shown to be associated with MS and class III obesity at 24 years [94].…”

Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Women with Polycystic Ovarian Syndrome

“…2 The disease begins soon after puberty mostly at 15 to 25 years of age and manifests during the reproductive period. 3 It is primarily characterized by ovulatory dysfunction and hyperandrogenism. The risk for diabetes has been seen to be higher in women with PCOS.…”