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Evaluation for Insulin Resistance and Comorbidities Related to Insulin Resistance in Polycystic Ovary Syndrome

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Insulin Resistance and Polycystic Ovarian Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Patients with polycystic ovary syndrome (PCOS) often have coexisting insulin resistance (IR), glucose intolerance or diabetes, and metabolic syndrome. For larger epidemiological studies, detection of IR may be accomplished using surrogate measures, such as the homeostatic model assessment or the quantitative insulin-sensitivity check index. Alternatively, research studies of IR, particularly those involving a smaller number of subjects, should strive to utilize the clamp, the frequently sampled intravenous glucose tolerance test, the insulin suppression test, or oral glucose tolerance test techniques. Clinically, in PCOS the standard 2-hour oral glucose tolerance test, measuring both insulin and glucose, yields the highest amount of information for a reasonable cost and risk, providing an assessment of both the degrees of hyperinsulinemia and glucose tolerance. However, considering the current variability in insulin assays, each laboratory should set its own normal range and establish a method for periodically reevaluating the acceptability of their results. Up to 25% of nonobese patients and 50% of obese patients with PCOS will have features consistent with the metabolic syndrome. Detection of the metabolic syndrome will include obtaining a thorough medical history, waist and hip circumferences, blood pressure measures, calculation of the body mass index, a lipid profile, and either serum-fasting glucose levels or, preferably, the glucose response to a standard OGTT.

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References

  1. Legro R, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998;83: 2694–2698.

    Article  CAS  PubMed  Google Scholar 

  2. DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assesment. Fertil Steril 2005;83:1454–1460.

    Article  CAS  PubMed  Google Scholar 

  3. Dokras A, Bochner M, Hollinrake E, Markham S, Vanvoorhis B, Jagasia DH. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol 2005;106:131–137.

    PubMed  Google Scholar 

  4. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. Obstet Gynecol Surv 2005;60:589–591.

    Article  Google Scholar 

  5. Sam S, Legro RS, Bentley-Lewis R, Dunaif A. Dyslipidemia and metabolic syndrome in the sisters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:4797–4802.

    Article  CAS  PubMed  Google Scholar 

  6. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999; 22:141–146.

    Article  CAS  PubMed  Google Scholar 

  7. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–169.

    Article  CAS  PubMed  Google Scholar 

  8. Ehrmann DA, Kasza K, Azziz R, Legro RS, Ghazzi MN. PCOS/Troglitazone Study Group. Effects of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:66–71.

    Article  CAS  PubMed  Google Scholar 

  9. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev 2003;24:302–312.

    Article  PubMed  Google Scholar 

  10. American Diabetes Association. Consensus development conference on insulin resistance. Diabetes Care 2001;24:588–597.

    Article  Google Scholar 

  11. Le Roith D, Zick Y. Recent advances in our understanding of insulin action and insulin resistance. Diabetes Care 2001;24:588–597.

    Article  PubMed  Google Scholar 

  12. Karter AJ, Mayer-Davis EJ, Selby JV, et al. Insulin sensitivity and abdominal obesity in African-American, Hispanic, and non-Hispanic white men and women. The Insulin Resistance and Atherosclerosis Study. Diabetes 1996;45:1547–1555.

    CAS  Google Scholar 

  13. Radziuk J. Insulin sensitivity and its measurement: structural commonalities among the methods. J Clin Endocrinol Metab 2000;85:4426–4433.

    Article  CAS  PubMed  Google Scholar 

  14. Ferrannini, E, Mari A. How to measure insulin sensitivity. J Hypertens 1998;16:895–906.

    Article  CAS  PubMed  Google Scholar 

  15. Elahi D. In praise of the hyperglycemic clamp. A method for assessment of beta-cell sensitivity and insulin resistance. Diabetes Care 1996;19:278–286.

    Article  CAS  PubMed  Google Scholar 

  16. Foley JE, Chen YD, Lardinois CK, Hollenbeck CB, Liu GC, Reaven GM. Estimates of in vivo insulin action in humans: comparison of the insulin clamp and the minimal model techniques. Horm Metab Res 1985;17:406–409.

    Article  CAS  PubMed  Google Scholar 

  17. Bergman RN. Lilly lecture 1989. Toward physiological understanding of glucose tolerance. Minimal-model approach. Diabetes 1989;38:1512–1527.

    Article  CAS  PubMed  Google Scholar 

  18. Yang YJ, Youn JH, Bergman RN. Modified protocols improve insulin sensitivity estimation using the minimal model. Am J Physiol 1987;253:E595–E602.

    CAS  PubMed  Google Scholar 

  19. Pei D, Jones CN, Bhargava R, Chen YD, Reaven GM. Evaluation of octreotide to assess insulin-mediated glucose disposal by the insulin suppression test. Diabetologia 1994;37:843–845.

    Article  CAS  PubMed  Google Scholar 

  20. Akinmokun A, Selby PL, Ramaiya K, Alberti KG. The short insulin tolerance test for determination of insulin sensitivity: a comparison with the euglycaemic clamp. Diabet Med 1992;9: 432–437.

    Article  CAS  PubMed  Google Scholar 

  21. Bonora E, Moghetti P, Zancanaro C, et al. Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies. J Clin Endocrinol Metab 1989;68:374–378.

    Article  CAS  PubMed  Google Scholar 

  22. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999;22:1462–1470.

    Article  CAS  PubMed  Google Scholar 

  23. Breda E, Cavaghan MK, Toffolo G, Polonsky KS, Cobelli C. Oral glucose tolerance test minimal model indexes of beta-cell function and insulin sensitivity. Diabetes 2001;50:150–158.

    Article  CAS  PubMed  Google Scholar 

  24. Penesova A, Radikova Z. Comparison of insulin sensitivity indices calculated from standard 3-sampled and frequently sampled oral glucose tolerance test. Endocr Regul 2004;38:167–171.

    PubMed  Google Scholar 

  25. Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000;23:171–175.

    Article  CAS  PubMed  Google Scholar 

  26. Hollenbeck CB, Chen N, Chen Y-DI, Reaven GM. Relationship between the plasma insulin response to oral glucose and insulin-stimulated glucose utilization in normal subjects. Diabetes 1984;33:460–463.

    Article  CAS  PubMed  Google Scholar 

  27. Quon MJ. Editorial: limitations of the fasting glucose to insulin ratio as an index of insulin sensitivity. J Clin Endocrinol Metab 2001;86:4615–4617.

    Article  CAS  PubMed  Google Scholar 

  28. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419.

    Article  CAS  PubMed  Google Scholar 

  29. Diamanti-Kandarakis E, Kouli C, Alexandraki K, Spina G. Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:1273–1276.

    Article  CAS  PubMed  Google Scholar 

  30. Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care 1998;21:2191–2192.

    Article  CAS  PubMed  Google Scholar 

  31. Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000;85:2402–2410.

    Article  CAS  PubMed  Google Scholar 

  32. Rabassa-Lhoret R, Bastard JP, Jan V, et al. Modified Quantitative Insulin Sensitivity Check Index is better correlated to hyperinsulinemic glucose clamp than other fasting-based index of insulin sensitivity in different insulin-resistant states. J Clin Endocrinol Metab 2003;88:4917–4923.

    Article  Google Scholar 

  33. Robbins DC, Andersen L, Bowsher R, Chance R, Dineson B, Frank B. Report of the American Diabetes Association’s task force on standardization of the insulin assay. Diabetes 1996;45:242–256.

    Article  CAS  PubMed  Google Scholar 

  34. Radikova Z. Assessment of insulin sensitivity/resistance in epidemiological studies. Endocr Regul 2003;37:189–194.

    PubMed  Google Scholar 

  35. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–1197.

    Google Scholar 

  36. World Health Organization. Diabetes Mellitus: Report of a WHO Study Group. Geneva: WHO, 1985; Technical Report Series 727.

    Google Scholar 

  37. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001;111:607–613.

    Article  CAS  PubMed  Google Scholar 

  38. Legro RS, Azziz R, Ehrmann D, et al. Minimal response of circulating lipids in women with polycystic ovary syndrome to improvement in insulin sensitivity with troglitazone. J Clin Endocrinol Metab 2003;88:5137–5144.

    Article  CAS  PubMed  Google Scholar 

  39. Brown CD, Higgins M, Donato KA, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000;8:605–619.

    Article  CAS  PubMed  Google Scholar 

  40. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med 2004;164:1066–1076.

    Article  PubMed  Google Scholar 

  41. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. National Heart, Lung, and Blood Institute, American Heart Association: definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–438.

    Article  PubMed  Google Scholar 

  42. World Health Organization: Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Geneva, WHO, 1999.

    Google Scholar 

  43. Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.

    Article  Google Scholar 

  44. Balkau B, Charles MA, Drivsholm T, et al. Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab 2002;28:364–376.

    PubMed  Google Scholar 

  45. Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003;9:237–252.

    PubMed  Google Scholar 

  46. Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005;28:2289–2304.

    Article  PubMed  Google Scholar 

  47. Vrbikova J, Vondra K, Cibula D, et al. Metabolic syndrome in young Czech women with polycystic ovary syndrome. Hum Reprod 2005;20:3328–3332.

    Article  CAS  PubMed  Google Scholar 

  48. Vural B, Caliskan E, Turkoz E, Kilic T, Demirci A. Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Hum Reprod 2005;20:2409–2413.

    Article  PubMed  Google Scholar 

  49. Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA. Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod 2003;18: 2289–2293.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ob/Gyn, Cedars-Sinai Medical Center, Los Angeles, CA

    Ricardo Azziz MD, MPH, MBA

  2. Departments of Ob/Gyn and Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, CA

    Ricardo Azziz MD, MPH, MBA

Authors
  1. Ricardo Azziz MD, MPH, MBA
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Editor information

Editors and Affiliations

  1. Endocrine Section of First Department of Internal Medicine, Athens University School of Medicine, Athens, Greece

    Evanthia Diamanti-Kandarakis MD, PhD

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

    John E. Nestler MD

  3. Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios Panidis MD, PhD

  4. Endocrinology Unit, Department of Internal Medicine and Gastroenterology and C.R.B.A., S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Renato Pasquali MD

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© 2007 Humana Press Inc.

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Azziz, R. (2007). Evaluation for Insulin Resistance and Comorbidities Related to Insulin Resistance in Polycystic Ovary Syndrome. In: Diamanti-Kandarakis, E., Nestler, J.E., Panidis, D., Pasquali, R. (eds) Insulin Resistance and Polycystic Ovarian Syndrome. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-310-3_1

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  • DOI: https://doi.org/10.1007/978-1-59745-310-3_1

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-763-1

  • Online ISBN: 978-1-59745-310-3

  • eBook Packages: MedicineMedicine (R0)

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