Background: Insulin resistance is a core pathophysiology of polycystic ovary syndrome (PCOS). The screening recommendations for type 2 diabetes in PCOS patients have varied according to organizations, but the AE-PCOS Society recommended that a OGTT be performed in obese patients or in lean patients with advanced age (>40 year), with a history of gestational diabetes, or with a family history of type 2 diabetes. Recently, the American Diabetes Association (ADA) newly includes hemoglobin A1c (A1C) as a component of diagnostic criteria of diabetes (≥6.5%) or increased risk for diabetes (5.76.4%). This study was performed to examine the prevalence and the risk factors for elevated A1C (≥5.7%) in women with PCOS compared to age matched control women.
Methods: A1C was evaluated in 154 patients and 469 controls.
Results: One-third (31.2%) of the PCOS patients had elevated A1C. The prevalence of elevated A1C was similar in obese PCOS and obese controls (23.5 and 20.0%, respectively, P=1.0), but non-obese PCOS women (mean age 29.8±5.4 years) had a higher prevalence of elevated A1C than non-obese controls (31.2 vs 6.6%, respectively, P<0.001). The prevalence of elevated fasting plasma glucose was not different. The odds that a woman has an elevated A1C was 6.7 times higher if she has PCOS (adjusted OR 6.67, 95% CI 3.5012.70).
Conclusions: Non-obese PCOS patients presented a significantly higher prevalence of elevated A1C than non-obese controls, whereas in obese subjects, the prevalence of elevated A1C was similarly elevated. Since substantial proportion of young and non-obese PCOS women are at an increased risk for diabetes, screening for type 2 diabetes may be necessary even in these young and non-obese PCOS patients. Future studies is mandatory to assess whether A1C is as effective as OGTT as a diagnostic tool in patients with PCOS.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.