Polycystic Ovary Syndrome (PCOS) in Juvenile and Adult Type 1 Diabetes in a German/Austrian Cohort

Abstract

While an association between PCOS and type 2 diabetes is well established, to date there have been few data on clinical care of type 1 diabetes (T1D) patients with PCOS. The aim of our study was to characterize T1D patients with the comorbidity of PCOS within the DPV cohort with regard to diabetes phenotype, therapy and metabolic control. Clinical data from the prospective German/Austrian DPV cohort on patients with T1D and documented PCOS (n=76) were compared to female T1D controls (n=32,566) in reproductive age. The age at T1D manifestation in PCOS patients was later than in the control group (14.9±8.2 vs. 11.8±7.0 years, p<0.001). PCOS patients had higher BMI-SDS (0.92±0.11 vs. 0.38±0.01, p<0.001), metformin and oral contraceptives were used more frequently (p<0.001). A1c levels were significantly lower (7.92 +/- 0.23% vs. 8.43±0.01%, p<0.05) despite of lower insulin requirements (0.76±0.04 IU/kg/d vs. 0.84±0.00 IU/kg/d, p<0.05). In the PCOS group, higher rates of dyslipidemia (63.4 vs. 48.7%, p =0.032) and thyroid disorders (42.2% vs. 21.2%, p<0.001) were present. While patients with T1D and comorbid PCOS showed features of a "type 1.5 diabetes" phenotype, insulin requirements per kg body weight were not higher and metabolic control was better, which could be explained only partially by additional metformin therapy. A more precise genetic and metabolic characterisation of these patients is needed to answer open questions on the underlying autoimmune process and residual ß-cell function.

Prevalence of polycystic ovary syndrome and its clinical and hormonal profile in young females with type 1 diabetes mellitus: experience from a teaching institution of India

“…High prevalence of menstrual irregularities, hyperandrogenism and PCOS has been reported in females with T1DM in other populations too [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. Results of our study are consistent with a large meta-analysis [34] including 478 girls and women (in which 24% of them had PCOS comparable to 27% in current study).…”

“…Unlike our study, analysis from a large prospective registry [10] of women with T1DM and PCOS (compared to T1DM alone) had signi cantly higher age of diabetes onset (14.9 ± 8.2 vs 11.8 ± 7.0 years p < 0.001), and higher BMI Z-score (0.92 ± 0.11 Vs 0.38 ± 0.01, p < 0.001).…”

“…About two decades ago for the rst time it was reported [4] that hyperandrogenism and menstrual irregularities are more common in females with type 1 diabetes irrespective of their glycaemic control. Studies from other parts of the world [5], [6], [7], [8], [9], [10], [11], [12], [13] reiterated these ndings. The explanation given was that the administration of insulin through a non-physiological subcutaneous route results in adequate insulin in portal vein and suppresses hepatic glucose output but also leads to supraphysiological levels in systemic circulation.…”

Polycystic ovary syndrome (PCOS) and the accompanying disorders of glucose homeostasis among girls at the time of puberty

“…For many years, the occurrence of PCO syndrome has been considered to be related to insulin resistance, associated with hyperinsulinemia and type 2 diabetes. Currently, there is an increasing number of reports emphasizing the presence of this syndrome amongst girls and women suffering from type 1 diabetes [30,39,40].…”