Endocrine Abstracts

Background: The prevalence of reproductive disturbances in women with Type 1 Diabetes Mellitus (T1DM) is high compared to the general population. One reason might be higher prevalence of Polycystic ovary syndrome (PCOS) in T1DM. In Sweden, with a high incidence of T1DM, the prevalence of PCOS in women with T1DM is not known. Neither is the T1DM-PCOS pathophysiology.

Aim: The aim of this cross-sectional study was to investigate the prevalence of PCOS in a Swedish T1DM population compared to population-based controls, as well as characterizing patients and controls with respect to hormonal and metabolic profile.

Method: A screening questionnaire covering medical background, gynaecological history and PCOS related symptoms was sent out to female T1DM patients of age 18-55 years in Stockholm. The questionnaire was also sent to women that were matched to the patient population by age and postal address and thus served as controls. Subjects who reported one or more symptoms related to PCOS or reported close female relatives with symptoms, were offered to participate in a clinical examination by a physician (including gynaecological examination with vaginal ultrasound, assessment of body hair by the modified Ferriman-Gallwey scale and fasting blood samples).

Results: 785 women with T1DM and 1152 controls were included in the questionnaire part of the study. 40.3 % vs 29.5 % (P<0.001) of women with T1DM and controls, respectively, reported having at least one screening symptom. Women with T1DM reported to a greater extent oligomenorrhea (25.1 % vs 17.1 %, P<0.001) as well as excessive hair growth (14.9 % vs 8.7 %, P<0.001) compared to controls. More women with T1DM than controls reported the combination of oligomenorrhea and excessive hair growth (5.1 % vs 2.6 %, P<0.01). 102 women with T1DM and 97 controls were subsequently included in the clinical examination. 34.3% of women with T1DM and 22.7% of controls fulfilled the Rotterdam criteria of PCOS, OR=1.8, (P=0.07). There was a higher rate of polycystic ovarian morphology in women with T1DM (45.5% vs 31.0 %, P<0.05) compared to controls. The rate of hyperandrogenism and oligomenorrhea was the same. When analysing PCOS positive subjects only, women with T1DM had significantly higher testosteron, SHBG, androstenedione and DHEAS compared to controls.

Conclusion: These results confirm the connection between symptoms of PCOS and T1DM, also in a Swedish population. Furthermore, in women with PCOS, hormonal deviances seem to be more pronounced in those with T1DM compared to controls.