Background and aims: It is well recognized that insulin resistance and type 2 diabetes (T2DM) are associated with an increased risk for cardiovascular disease especially in women, while the role of sex steroids is still controversial. Women with polycystic ovary syndrome (PCOS) represent a unique biological model for the study of the impact of all these factors on cardiovascular system. We aimed to evaluate the degree of low-grade inflammation and atherosclerosis in premenopausal diabetic women with or without PCOS by measurement of C-reactive protein (CRP) and common carotid intimal-medial thickness (IMT).
Subjects and methods: We studied 40 women with T2DM (mean age 43.2 years) treated with metformin and/or sulfonylourias and 30 healthy, normal cycling, age-matched women. According to gynaecological history (menstrual cycles≤8 per year) and the presence of hyperandrogenism (clinical or biochemical), diabetic women were divided in two groups: group 1 diabetic women with normal cycles and group 2 diabetic women with PCOS. We measured BMI, waist circumference (WC) and systolic blood pressure (SBP). Blood samples were collected after an overnight fast, during the 26 day of the cycle and hormones, lipids, glucose and CRP levels were determined. Carotid IMT was assessed by B-mode ultrasound imaging.
Results: No difference was found between diabetic and control women in age, smoking habits and the presence of hypertension. Diabetic women had significantly higher BMI (34.5±6.39 vs 27.9±6.1, P<0.001), WC (105.3±14 vs 86.9±11.2 cm, P<0.001), hirsutism score (1.78±0.9 vs 1.15±0.3, P<0.01) and a positive family history for T2DM (82.5% vs 34.6%, P<0.002). Additionally, they presented higher total testosterone (0.62±0.21 vs 0.45±0.11 ng/ml, P<0.001), insulin (17.8±11.9 vs 9.8±3.6 mIU/ml, P<0.002), triglycerides (131±23 vs 95±67 mg%, P=0.02) and LDL-cholesterol (132±31 vs 114±23 mg%, P=0.025) levels and lower SHBG (34.3±16.2 vs 53.9±18.7 nmol/l, P<0.001) and HDL-cholesterol (47.1±12.8 vs 57±10.9 mg%, P<0.001) levels compared to control women. Between diabetic women, patients in group 2 reported higher percentage of Pregnancy Diabetes (37.5% vs 8.3%, P<0.05) were younger at disease diagnosis (32.8±5.7 vs 39.7±6.1 years, P<0.001) and they had higher WC (115±12.8 vs 99±11.1 cm, P<0.01). Furthermore, they presented higher total testosterone (0.75±0.22 vs 0.54±0.16 ng/ml, P=0.01) and insulin (24±15.8 vs 14.4±7.5 mIU/ml, P<0.05), and lower SHBG (26.1±9.5 vs 39.8±17.6 nmol/l, P<0.001) and HDL-cholesterol (41.4±11.2 vs 50.8±12.6 mg/%, P<0.001) levels. Duration of T2DM and glycaemic control was the same in both groups but women in group 2 were younger (39.9±6.3 vs 44.5±3.6 years, P<0.02). Diabetic women had higher CRP levels (1.4±0.4 vs 0.8±0.2 mg/dl, P<0.05) and carotid IMT (0.065±0.007 vs 0.056±0.008 mm, P<0.001) compared to controls, while no difference was found between the two groups of diabetic women.
Conclusions: Premenopausal diabetic women have low-inflammation and accelerated atherosclerosis. High androgen levels do not seem to aggravate this process as in the case of diabetic women with PCOS.
03 - 07 May 2008
European Society of Endocrinology