Abstract
Purpose
To evaluate the relationship between obesity and insulin resistance among women with polycystic ovary syndrome (PCOS) using a gold standard test.
Methods
A retrospective database analysis of 75 women with PCOS and 118 normal controls who underwent a modification of the insulin suppression test. The relationships between body mass index (BMI) and steady-state plasma glucose (SSPG) levels were investigated.
Results
Mean SSPG score for PCOS subjects was statistically similar than that of the controls at all BMI groupings. Only when PCOS subjects reached a BMI of ≥30 kg/m2 that the PCOS subjects had higher mean SSPG score than the control subjects, although not significantly so (p = 0.07). The distribution of PCOS and control subjects in each SSPG quartile grouping was investigated. When comparing all PCOS and control subjects, PCOS subjects were more likely to be in the higher quartiles of SSPG score (p = 0.0001). However, when comparing the PCOS and control subjects, at each BMI grouping (<25, 25–29.9, and ≥30 kg/m2), there was no difference in the likelihood that a larger percent of subjects fell into a different quartile (p = 0.12, 0.69, 0.32, respectively).
Conclusions
PCOS subjects have increased magnitudes of insulin resistance when compared to ovulatory controls, when controlling for age, BMI, fasting glucose, and insulin levels. However, the magnitude of this insulin resistance in lean subjects is mild. Quantity of excess body fat, particularly subjects with a BMI of at least 30 kg/m2 is the primary predictor of insulin resistance of sufficient magnitude to put PCOS subjects at increased risk for metabolic abnormalities.
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References
D. Dunaif, K.R. Segal, W. Futterweit, A. Dobrjansky, Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 38, 1165–1174 (1989)
S. Toprak, A. Yonem, B. Cakir, S. Guler, O. Azal, M. Ozata, A. Corakci, Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm. Res. 55, 65–70 (2001)
P. Ovesen, J. Moller, H.J. Ingerslev, J.O. Jorgensen, A. Mengel, O. Schmitz, K.G. Alberti, N. Moller, Normal basal and insulin-stimulated fuel metabolism in lean women with the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 77, 1636–1640 (1993)
J. Holte, T. Bergh, C. Berne, L. Berglund, H. Lithell, Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance. J. Clin. Endocrinol. Metab. 78, 1052–1058 (1994)
J. Vrbikova, D. Cibula, K. Dvorakova, S. Stanicka, G. Sindelka, M. Hill, M. Fanta, K. Vondra, J. Skrha, Insulin sensitivity in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 89, 2942–2945 (2004)
G.M. Reaven, Role of insulin resistance in human disease. Diabetes 37, 1595–1607 (1988)
A. Dunaif, J. Mandeli, H. Fluhr, A. Dobrjansky, The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 66, 131–139 (1988)
F. Ovalle, R. Azziz, Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil. Steril. 77, 1095–1105 (2002)
D. Pei, C.N.O. Jones, R. Bhargava, Y.-D.I. Chen, G.M. Reaven, Evaluation of octreotide to assess insulinmediated glucose disposal by the insulin suppression test. Diabetologia 37, 843–845 (1994)
M.S. Greenfield, L. Doberne, F. Kraemer, T. Tobey, G. Reaven, Assessment of insulin resistance with theinsulin suppression test and the euglycemic clamp. Diabetes 30, 387–392 (1981)
J. Knowles, T.L. Assimes, P.S. Tsao, et al. Measurement of insulin mediated glucose uptake: Direct comparison of the modified insulin suppression test and the euglycemic, hyperinsulinemic clamp. Metabolism 62, 548–553 (2013)
Funding
Women’s Reproductive Health Research (WRHR) Scholars program, NIH through the NICHD, Grant Number: U54 HD031398.
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Dahan, M.H., Reaven, G. Relationship among obesity, insulin resistance, and hyperinsulinemia in the polycystic ovary syndrome. Endocrine 64, 685–689 (2019). https://doi.org/10.1007/s12020-019-01899-9
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DOI: https://doi.org/10.1007/s12020-019-01899-9