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Prevalence of diabetes, impaired glucose tolerance and insulin sensitivity in patients with polycystic ovary syndrome - a long term follow-up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

  

Background: The aim of this long-term follow-up study was to examine glucose tolerance and insulin sensitivity in middle-aged women previously diagnosed with PCOS in comparison with age-matched healthy controls.

Methods: Women diagnosed with PCOS between 1987 and 1995 were invited for the study. 84 PCOS patients and 87 control subjects, randomly selected from the general population, participated in the study. Anthropometric and metabolic parameters, including an oral glucose tolerance test, were examined.

Results: Eighteen (21.4 %) PCOS patients had type 1 or type 2 diabetes or impaired glucose tolerance at the follow-up investigation, which was significantly more common than in control subjects (4.5 %), p < 0.05. Following the adjustment for BMI, insulin sensitivity measured by the Matsuda insulin sensitivity index was significantly lower in women with PCOS and the insulinogenic index, as a measure of beta-cell function, was elevated in PCOS patients in comparison to control subjects. Furthermore, both women with persisting and resolved PCOS at the follow-up investigation displayed decreased Matsuda insulin sensitivity index and increased insulinogenic index in comparison with control subjects. Women without clinical signs of hyperandrogenism at the index assessment displayed higher fasting insulin and proinsulin plasma concentrations than controls at the follow-up investigation. In addition, they had lower Matsuda insulin sensitivity index and higher insulinogenic index than controls. When adjusted for BMI, there was also a trend towards significantly lower Matsuda insulin sensitivity index and increased insulinogenic index at the follow-up investigation among women who had presented with hyperandrogenism at the index assessment.

Conclusion: IGT and type 2 diabetes occurred more often in PCOS patients. Independent of PCOS phenotype at index assessment and persistence of PCOS symptoms at the follow-up investigation, women with PCOS had lower insulin sensitivity and increased beta-cell function in comparison with control subjects.  

Keyword [en]
Polycystic ovary syndrome, long-term follow-up, insulin sensitivity, impaired glucose tolerance, diabetes
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-123245OAI: oai:DiVA.org:uu-123245DiVA: diva2:313608
Available from: 2010-04-26 Created: 2010-04-26 Last updated: 2012-08-24
In thesis
1. Reproductive and Metabolic Consequences of the Polycystic Ovarian Syndrome
Open this publication in new window or tab >>Reproductive and Metabolic Consequences of the Polycystic Ovarian Syndrome
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Polycystic ovary syndrome (PCOS) is a complex clinical condition characterized by hyperandrogenism and chronic oligo/anovulation. Infrequent ovulation and metabolic alterations in women with PCOS are associated with subfertility and probably increased miscarriage rates compared with normal fertile women. The overall risk of developing type 2 diabetes and impaired glucose tolerance (IGT) is three- to sevenfold higher in PCOS women, and the onset of glucose intolerance seems to occur at an earlier age than in healthy controls. Women with PCOS also have several risk factors for cardiovascular disease, although it is unclear whether they actually experience more cardiovascular events than other women. Very few studies assessing the long-term reproductive and metabolic consequences in older women with previously confirmed PCOS have been conducted. In this long-term follow-up of women with PCOS, 84 women with a diagnosis of PCOS between 1987 and 1995 and age at the follow-up > 35 years and an age-matched population-based group of control women participated. Data on reproductive outcome, ovarian reserve, endothelial function, insulin sensitivity and beta-cell function were collected. According to our results most women with PCOS had given birth and the rate of spontaneous pregnancies was relatively high. The rate of miscarriages was not increased in PCOS patients and the ultrasound findings together with increased levels of anti-müllerian hormone suggested that their ovarian reserve is superior to women of similar age. PCOS women displayed signs of endothelial dysfunction, but this was largely due to the increased prevalence of independent risk factors for cardiovascular disease such as increased BMI, triglycerides and blood pressures. IGT and type 2 diabetes occurred more often in PCOS women. Free androgen levels and beta-cell function decreased over time whereas insulin sensitivity remained unchanged. Obesity at young age and progressive weight-gain rendered them more prone to be insulin resistant at the follow-up. Beta-cell function was increased in PCOS women in comparison with control subjects but declined over time. Independent of PCOS phenotype at the index assessment and persistence of PCOS symptoms at the follow-up investigation, premenopausal women with PCOS had lower insulin sensitivity and increased beta cell function in comparison with control subjects. Conclusion: The long-term reproductive outcomes of PCOS are similar compared to women with normal ovaries. Although symptoms and androgen levels are normalized over time, women with PCOS continue to display reduced insulin sensitivity and increased beta-cell function and they also have an increased risk of IGT and type 2 diabetes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 570
Keyword
polycystic ovarian syndrome, long-term follow-up, ovarian reserve, anti-Müllerian hormone, insulin sensitivity, early insuline response, impaired glucose tolerance, diabetes, endothelial function, endothelial-dependent vasodilation
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-123248 (URN)978-91-554-7826-1 (ISBN)
Public defence
2010-06-14, Rosénsalen, Uppsala University Hospital, Entrance 95/96, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-05-24 Created: 2010-04-26 Last updated: 2012-08-24

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Hudecova, Miriam

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