Is there a relationship between polycystic ovary syndrome and diabetes? And if so, what are the variations in female patients?
The large-scale, transparent health issues of the United States are beneficial to researchers — if not just because of patient sample size opportunities. Studies and analysis presented at the 2018 American Diabetes Association (ADA) 78th Scientific Sessions in Orlando, FL this week featured US-based trials that sometimes included thousands of patients with diabetes being treated in real-world settings.
But there's also value in non-US analysis. While attending ADA 2018, Andrea Dunaif, MD, chief of the Hilda and J. Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine, told MD Mag her interests in sessions had particularly leaned towards those focused on polycystic ovary syndrome (PCOS) in women.
Dunaif noted that much of the newest data in PCOS research has brought clearer answers to its characteristics and association to conditions such as type 2 diabetes (T2D). Though more work needs to be done in clinical settings both in and outside of the United States, Dunaif found take-home messages pertaining to patient screening.
Andrea Dunaif, MD: This has been a debate for a long time, of whether women with polycystic ovary syndrome are at increased risk for type 2 diabetes because of the disorder, or whether it's due to their increased risk of obesity, and whether there's ethnic variations.
This is because an original study showing a very increased risk for type 2 diabetes in women with polycystic ovary syndrome — done in the United States, where we have our obesity epidemic. Of the women that are obese, about 40-50% have impaired glucose tolerance, and about 20% of them already have type 2 diabetes.
But particularly in Europe, where they're less obese, and Australia, it's less clear. So one of the important abstracts that was presented at this meeting was a very large program study from Australia asking the question, "What's the incidence of actual type 2 diabetes development in women with PCOS, and is it all obesity?"
And the answer is that the incidence is increased, and is not related to obesity. So I think that's very important to see in another part of the world that's not quite so challenged with obesity that there's still very high prevalence rates of type 2 diabetes in PCOS, and that it's independent of obesity.
This is on the background of a study in Scandinavia showing significantly increased risks of type 2 diabetes — about four-fold increased rates, and at a significantly younger age. I think that's important for clinicians: that they really should be screening more patients with PCOS for type 2 diabetes.
There's other recent data suggesting that the best form of screening is not a fasting glucose or hemoglobin A1C, but a two-hour post-glucose screening. I think that's another important take-home message for physicians: how to screen.
Another presentation that I found very interesting was looking at the prevalence of type 2 diabetes in adolescent girls in a population-based study in a busy New York medical center, finding that 20% of girls in adolescence have impaired glucose tolerance.
I think these all add much more support to being concerned about type 2 diabetes risk in PCOS.
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