Endocrine Abstracts

Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition in women at reproductive age, in whom, glucose metabolism disturbances are commonly observed. In addition, overweight and obesity, especially visceral obesity, are more prevalent in PCOS women, which enhances the resistance to insulin action, and as consequence, the onset of impaired glucose tolerance (IGT) and/or type 2 diabetes mellitus (T2DM). Clinical guidelines recommend oral glucose tolerance test (OGTT) in all PCOS patients as a screening tool; however, other authors suggest that this test should only be considered in case of obese patients, older than 40 years, and/or in hyperandrogenemic phenotypes.

Methods: Observational transversal study that included 379 PCOS women, recruited between 1998 – 2017, in whom a 75-gr OGTT was performed for the assessment of glucose metabolism disturbances. Diagnostic agreement was observed between fasting and 120-min glucose concentrations in all patients, and after stratifying them by BMI, age and circulating androgen concentrations.

Results: 14% of the patients showed impaired fasting glucose while OGTT detected IGT in 16% of the cases, and T2DM in 2%. When fasting glucose was normal, OGTT detected IGT in 13% of patients, percentage that rose to 50% when fasting glucose was ≥100 mg/dl. OGTT detected IGT in 6% of lean patients, 15% when overweight, and 18% in obese women with normal fasting glucose. Hyperandrogenemic phenotypes presented IGT in 14% of the cases, while 10% of non-hyperandrogenemic women showed values ≥140 mg/dl. In younger patients (<40-year-old) with normal fasting glucose, IGT was present in 13% of them, conversely, in women older than 40 years, glucose concentrations ≥140 mg/dl after OGTT was observed in the 66% of the cases who previously had glucose values ≤100 mg/dl. Finally, in the 95% of patients with normal fasting glucose values, a normal response after OGTT was observed in younger, non-hyperandrogenemic patients with normal BMI.

Conclusions: OGTT is the method of choice for IGT screening and should be performed in all overweight/obese PCOS women. A fasting glucose determination could detect 95% of pre-diabetic conditions in lean, younger and non-hyperandrogenemic PCOS women.