Abstract
Objective
To investigate the prevalence of polycystic ovary syndrome and its clinical and hormonal profile in females with type 1 diabetes.
Materials and methods
65 T1DM females were evaluated for presence of PCOS by Rotterdam ESHRE/ASRM consensus criteria and compared with age and BMI matched females with PCOS without diabetes and females with T1DM without PCOS.
Results
According to Rotterdam criteria 18/65 (27%) had PCOS. Prevalence of androgen excess, hirsutism, menstrual dysfunction and PCOM was 26%, 3%, 21% and 52%, respectively. Females with T1DM who had PCOS did not differ from females with T1DM without PCOS. When the group of T1DM with PCOS was compared with PCOS females without diabetes, they had significantly lower hirsutism score (median, IQR; 1.5, 0–3 vs. 11.5, 0–16.5, p = 0.04), significantly higher waist hip ratio (0.91, 0.89–0.99 vs. 0.86, 0.80–0.89, p = 0.004) and SHBG (in nmol, 54.4, 38–86.2 vs. 28.3, 20.4–37.4, p = 0.004).
Conclusion
Females with T1DM have a high prevalence of menstrual abnormalities, hyperandrogenism and PCOS which is not related to metabolic control, age of onset of diabetes or insulin dose. Polycystic ovary syndrome, hyperandrogenism, type 1 diabetes, menstrual irregularity, hirsutism.
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Funding
Intramural academic grant from author’s institute (Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India). Grant no.- PGI/DIR/R.C./205/2015.
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P.D. conceptualised, and planned the study, contributed to data analysis and in editing and finalising the manuscript. N.D. planned the study, did literature search, data collection and data analysis and wrote the manuscript. N.M. planned the study, did ultrasonography of all the patients, did data collection, wrote, and edited the manuscript. L.S. did literature search and data analysis, and wrote and edited the manuscript. All authors read and approved the final manuscript.
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The study was approved by the Institutional Ethics Committee and adheres to the guidelines of Helsinki declaration (IEC code 2014-201-DM-EXP numbered PGI/BE/898/2014).
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At the time of recruitment all subjects signed an informed consent and in case of minors, informed consent was taken from caregivers along with assent from the subjects for participation and publication of their data.
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Annexure 1
Annexure 1
Assays
Biochemical analyses were done on the same day, by autoanalyzer (RX imola, Randox labs, UK). Serum levels of FSH, LH, prolactin, TSH and SHBG were estimated with chemiluminescence analyser (Immulite 1000, Siemens, Tarrytown, NY). Serum testosterone, DHEAS and 17- OH progesterone were measured by radioimmunoassay (Immunotech, Beckman Coulter, Marseille, France). Analytical sensitivity, intra-assay and inter-assay coefficient of variation (CV) were 0.069 nmo/L, 5.6% and 15%, and 0.072 µmol/L, 4.93% and 9.32%, respectively for testosterone and DHEAS assays. Glycosylated haemoglobin level was measured with cation exchange high performance liquid chromatography (BIO-RAD VARIANT II, California, USA).
Free androgen index (FAI) was calculated as the ratio of testosterone to SHBG (both in nmol/l) multiplied by 100. Biochemical hyperandrogenism was defined as: total testosterone ≥1.7 nmo/l or DHEAS ≥ 8 μmol/L (calculated on the basis of the 95th percentile of basal serum androgen concentrations in 97 girls aged between 18 and 25 years with normal menstrual cycles and no features of hyperandrogenism used as a control group in a previous study of same population) [42].
Anthropometric measurements:
Anthropometric measurements included weight, height, waist circumference (WC, measured at the midpoint between the lateral iliac crest and lower rib margin at the end of normal expiration), waist to hip ratio (WHR), with hip measured at the widest level of the greater trochanters with minimal clothing.
We have used WHR norms from an Indian study [43]. In this study authors concluded cut-off of normal WHR as 0.81 and 0.88 for women and men, respectively.
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Dominic, N., Sharma, L., Mohindra, N. et al. Prevalence of polycystic ovary syndrome and its clinical and hormonal profile in young females with type 1 diabetes mellitus: experience from a teaching institution of India. Endocrine 82, 303–310 (2023). https://doi.org/10.1007/s12020-023-03470-z
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DOI: https://doi.org/10.1007/s12020-023-03470-z