SCREENING OF PRE-DIABETES IN PATIENTS PRESENTING WITH POLYCYSTIC OVARIAN SYNDROME: A TERTIARY CARE EXPERIENCE

Main Article Content

Akhtar Hussain
Sobia Sabir Ali
Ibrar Ahmad
Muhammad Nawaz Khan
Syeda Hira Tahir

Abstract

OBJECTIVE: To screen the females presenting with Polycystic Ovarian Syndrome (PCOS) for underlying pre-diabetes and to correlate pre-diabetes with the various diagnostic criteria of PCOS.


METHODS: This descriptive cross-sectional study was conducted at Lady Reading Hospital Peshawar, Pakistan from March, 2020 till December, 2020. One hundred & fifty one cases of PCOS, ranging in age from 17-40 years, were selected through purposive sampling. The Rotterdam criterion was used to diagnose PCOS, the details of history, physical examination and biochemical investigations like luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, thyroid stimulating hormone (TSH), glycosylted hemoglobin (HBA1c), prolactin and pelvic ultrasound were recorded on a structured questionnaire.


RESULTS: Mean age of the patients was 23.42±4.88 years. Mean BMI was 33.27±26.98 kg/m2. Pre-diabetes was detected in 19.2% (n=29) and overt diabetes in 4.0% (n=6) of the women with PCOS.  Hypertension, dyslipidemia and hypothyroidism were reported by 11 (7.2%), 9 (5.9%) and 4 (2.6%) patients respectively. Delayed menstrual cycle was reported by 44.8% (n=52); 27.6% (n=8) & 33.3% (n=2) cases of normoglycemic, prediabetes and diabetes mellitus respectively. Oligomenorrhoea was present in 69.0% (n=20) of pre-diabetics. Moderate and severe hirsutism was present in 44.8% and 10.3% PCOS patients with pre-diabetes. There was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis.


CONCLUSION: Women with PCOS are at increased risk of pre-diabetes and other metabolic complications like obesity, hypertension and dyslipidemia at an earlier age. However, there was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis.

Article Details

How to Cite
Hussain, A., S. Ali, I. Ahmad, M. Khan, and S. Tahir. “SCREENING OF PRE-DIABETES IN PATIENTS PRESENTING WITH POLYCYSTIC OVARIAN SYNDROME: A TERTIARY CARE EXPERIENCE”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 14, no. 4, Dec. 2021, pp. 237-43, doi:10.35845/kmuj.2021.21988.
Section
Original Articles

References

1. Dargham SR, Ahmed L, Kilpatrick ES, Atkin SL. The prevalence and metabolic characteristics of polycystic ovary syndrome in the Qatari population. PLoS One 2017;12(7):e0181467. https://doi.org/10.1371/journal.pone.0181467.
2. EI Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Polycystic ovarian syndrome : an updated overview. Front Physiol 2016;7:124. https://doi.org/10.3389/fphys.2016.00124.
3. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1. Endocr Pract 2015;21(11):1291-300. https://doi.org/10.4158/EP15748.DSC.
4. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014;171(4):P1-29. https://doi.org/10.1530/EJE-14-0253.
5. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et at. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society Guideline. J Clin Endocrinol Metab 2006;91(11):4237-45. https://doi.org/10.1210/jc.2006-0178.
6. Ollila MM, West S, Keinänen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, et al. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod 2017;32(2):423-31. https://doi.org/10.1093/humrep/dew329.
7. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010;16(4):347-63. https://doi.org/10.1093/humupd/dmq001.
8. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010;25(2):544-51. https://doi.org/10.1093/humrep/dep399.
9. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98(12):4565-92. https://doi.org/10.1210/jc.2013-2350.
10. Joham AE, Ranasinha S, Zoungas S, Moran L, Teede HJ. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab 2014;99(3):E447-52. https://doi.org/10.1210/jc.2013-2007.
11. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004 Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81(1):19-25. doi: 10.1016/j.fertnstert.2003.10.004.
12. Pelanis R, Mellembakken JR, Sundström-Poromaa I, Ravn P, Morin-Papunen L, Tapanainen JS, et al. The prevalence of Type 2 diabetes is not increased in normal-weight women with PCOS. Human Reprod 2017;32(11):2279-86. https://doi.org/10.1093/humrep/dex294.
13. Wang ET, Calderon-Margalit R, Cedars MI, Daviglus ML, Merkin SS, Schreiner PJ, et al. Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstet Gynecol 2011;117(1):6-13. https://doi.org/10.1097/AOG.0b013e31820209bb.
14. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance? Fertil Steril 2012;97(1):18-22. https://doi.org/10.1016/j.fertnstert.2011.11.036.
15. Morgan CL, Jenkins-Jones S, Currie CJ, Rees DA. Evaluation of adverse outcome in young women with polycystic ovary syndrome versus matched, reference controls: a retrospective, observational study. J Clin Endocrinol Metab 2012;97(9):3251-60. https://doi.org/10.1210/jc.2012-1690.
16. Velija-Asimi Z, Burekovic A, Dujic T, Dizdarevic-Bostandzic A, Semiz S. Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome. Bosn J Basic Med Sci 2016;16(4):298-306. https://doi.org/10.17305/bjbms.2016.1428.
17. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84(1):165-9. https://doi.org/10.1210/jcem.84.1.5393.
18. Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91(4):1357-63. https://doi.org/10.1210/jc.2005-2430.
19. Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf) 2000;52(5):595-600. https://doi.org/10.1046/j.1365-2265.2000.01000.x.
20. Lunde O, Tanbo T. Polycystic ovary syndrome: a follow-up study on diabetes mellitus, cardiovascular disease and malignancy 15–25 years after ovarian wedge resection. Gynecol Endocrinol 2007;23(12):704-9. https://doi.org/10.1080/09513590701705189.
21. Chen X, Yang D, Li L, Feng S, Wang L. Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome. Hum Reprod 2006;21(8):2027-32. https://doi.org/10.1093/humrep/del142.
22. Lee H, Oh JY, Sung YA, Chung H, Cho WY. The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome. Endocrine 2009;36(2):326-32. https://doi.org/10.1007/s12020-009-9226-7.
23. Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T, et al. Association of androgen excess with glucose intolerance in women with polycystic ovary syndrome. Biomed Res Int 2018;2018:6869705. https://doi.org/10.1155/2018/6869705.
24. Ibricevic D, Asimi ZV. Frequency of prediabetes in women with polycystic ovary syndrome. Med Arch 2013;67(4):282-5. https://doi.org/10.5455/medarh.2013.67.282-285.
25. Escobar-Morreale HF, Roldán B, Barrio R, Alonso M, Sancho J, de la Calle H, et al. High prevalence of the polycystic ovary syndrome and hirsutism in women with type 1 diabetes mellitus. J Clin Endocrinol Metab 2000;85(11):4182-7. https://doi.org/10.1210/jcem.85.11.6931.