Advertisement

Endocrine

, Volume 36, Issue 2, pp 326–332 | Cite as

The prevalence and risk factors for glucose intolerance in young Korean women with polycystic ovary syndrome

  • Hyejin LeeEmail author
  • Jee-Young Oh
  • Yeon-Ah Sung
  • Hyewon Chung
  • Wha Young Cho
Original Article

Abstract

Insulin resistance and hyperinsulinemia play important roles in the pathogenesis of polycystic ovary syndrome (PCOS). In addition, some women with PCOS have been shown to have insulin secretory defects and can be predicted to be at an increased risk for glucose intolerance. We performed the present study to determine the prevalence and risk factors for glucose intolerance in Korean women with PCOS. We consecutively recruited 194 women with PCOS diagnosed by American Society for Reproductive Medicine/European Society of Human Reproduction and Embryology (ASRM/ESHRE) criteria. Anthropometric measures, 75 g oral glucose tolerance test (OGTT), and measurement of insulin sensitivity (insulin mediated glucose uptake; IMGU) using euglycemic hyperinsulinemic clamp technique were performed. In women with PCOS, the prevalence of impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) was 17.0% and type 2 diabetes 1.0%, and in lean women with PCOS, the prevalence of IGT and/or IFG was 5.9%. The prevalence of glucose intolerance was 28-fold higher in women with PCOS, and 9.8-fold higher in lean women with PCOS compared to age-matched Korean women. Women with glucose intolerance had higher BMI, waist circumference, free testosterone, fasting insulin, 2-h post-load insulin, total cholesterol, LDL cholesterol, triglyceride and lower sex hormone binding globulin and IMGU than women with normal glucose tolerance (NGT) (P < 0.05). IMGU was the most powerful predictor for glucose intolerance after adjustment for age, BMI, waist circumference, and hyperandrogenemia. The 2-h OGTT was the best screening measure for glucose intolerance and diagnosis of diabetes in women with PCOS. Young Korean women with PCOS have high prevalence for glucose intolerance and type 2 diabetes, and insulin resistance is the most important factor associated with glucose intolerance.

Keywords

Glucose intolerance Polycystic ovary syndrome Prevalence 

References

  1. 1.
    A. Dunaif, A. Thomas, Current concepts in the polycystic ovary syndrome. Annu. Rev. Med. 52, 401–419 (2001)CrossRefPubMedGoogle Scholar
  2. 2.
    A. Dunaif, Insulin resistance, the polycystic ovary syndrome: mechanism, implications for pathogenesis. Endocr. Rev. 18, 774–800 (1997)CrossRefPubMedGoogle Scholar
  3. 3.
    R.S. Legro, A.R. Kunselman, W.C. Dodson, A. Dunaif, Prevalence predictors of risk for type 2 diabetes mellitus, impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J. Clin. Endocrinol. Metab. 84, 165–169 (1999)CrossRefPubMedGoogle Scholar
  4. 4.
    S. Lillioja, D.M. Mott, M. Spraul, R. Ferraro, J.E. Foley, E. Ravussin, W.C. Knowler, P.H. Bennett, C. Bogardus, Insulin resistance, insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N. Engl. J. Med. 329, 1988–1992 (1993)CrossRefPubMedGoogle Scholar
  5. 5.
    D.A. Ehrmann, R.B. Barnes, R.L. Rosenfield, M.K. Cavaghan, J. Imperial, Prevalence of impaired glucose tolerance, diabetes in women with polycystic ovary syndrome. Diabetes Care 22, 141–146 (1999)CrossRefPubMedGoogle Scholar
  6. 6.
    X. Chen, D. Yang, L. Li, S. Feng, L. Wang, Abnormalglucose tolerance in Chinese women with polycystic ovary syndrome. Hum. Reprod. 21, 2027–2032 (2006)CrossRefPubMedGoogle Scholar
  7. 7.
    S. Weerakiet, C. Srisombut, P. Bunnag, S. Sangtong, N. Chuangsoongnoen, A. Rojanasakul, Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in Asian women with polycystic ovary syndrome. Int. J. Gynaecol. Obstet. 75, 177–184 (2001)CrossRefPubMedGoogle Scholar
  8. 8.
    A. Dunaif, K.R. Segal, W. Futterweit, A. Dobrjansky, Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 38, 1165–1174 (1989)CrossRefPubMedGoogle Scholar
  9. 9.
    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, normal glucose tolerance. J. Clin. Endocrinol. Metab. 78, 1052–1058 (1994)CrossRefPubMedGoogle Scholar
  10. 10.
    P. Ovesen, J. Moller, H.J. Ingerslev, J.O. Jorgensen, A. Mengel, O. Schmitz, K.G. Alberti, N. Moller, Normal basal, insulin-stimulated fuel metabolism in lean women with the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 77, 1636–1640 (1993)CrossRefPubMedGoogle Scholar
  11. 11.
    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)CrossRefPubMedGoogle Scholar
  12. 12.
    D. Cibula, G. Sindelka, M. Hill, M. Fanta, J. Skrha, J. Zivny, Insulin sensitivity in non-obese women with polycystic ovary syndrome during treatment with oral contraceptives containing low-androgenic progestin. Hum. Reprod. 17, 76–82 (2002)CrossRefPubMedGoogle Scholar
  13. 13.
    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)CrossRefPubMedGoogle Scholar
  14. 14.
    J. Vrbikova, K. Dvorakova, T. Grimmichova, M. Hill, S. Stanicka, D. Cibula, B. Bendlova, L. Starka, K. Vondra, Prevalence of insulin resistance, prediction of glucose intolerance, type 2 diabetes mellitus in women with polycystic ovary syndrome. Clin. Chem. Lab. Med. 45, 639–644 (2007)CrossRefPubMedGoogle Scholar
  15. 15.
    B. Trolle, F.F. Lauszus, Risk factors for glucose intolerance in Danish women with polycystic ovary syndrome. Acta Obstet. Gynecol. Scand. 84, 1192–1196 (2005)PubMedGoogle Scholar
  16. 16.
    M. Möhlig, J. Spranger, M. Ristow, A.F. Pfeiffer, T. Schill, H.W. Schlösser, L. Moltz, G. Brabant, C. Schöfl, Predictors of abnormal glucose metabolism in women with polycystic ovary syndrome. Eur. J. Endocrinol. 154, 295–301 (2006)CrossRefPubMedGoogle Scholar
  17. 17.
    H.J. Wei, R. Young, I.L. Kuo, C.M. Liaw, H.S. Chiang, C.Y. Yeh, Prevalence of insulin resistance and determination of risk factors for glucose intolerance in polycystic ovary syndrome: a cross-sectional study of Chinese infertility patients. Fertil. Steril. 91, 1864–1868 (2009)CrossRefPubMedGoogle Scholar
  18. 18.
    A. Gambineri, C. Pelusi, E. Manicardi, V. Vicennati, M. Cacciari, A.M. Morselli-Labate, U. Pagotto, R. Pasquali, Glucose intolerance in a large cohort of mediterranean women with polycystic ovary syndrome: phenotype, associated factors. Diabetes 53, 2353–2358 (2004)CrossRefPubMedGoogle Scholar
  19. 19.
    WHO Expert Consultation, Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157–163 (2004)CrossRefGoogle Scholar
  20. 20.
    S. Dickinson, S. Colagiuri, E. Faramus, P. Petocz, J.C. Brand-Miller, Postprandial hyperglycemia, insulin sensitivity differ among lean young adults of different ethnicities. J. Nutr. 132, 2574–2579 (2002)PubMedGoogle Scholar
  21. 21.
    M. Chandalia, N. Abate, A. Garg, J. Stray-Gundersen, S.M. Grundy, Relationship between generalized, upper body obesity to insulin resistance in Asian Indian men. J. Clin. Endocrinol. Metab. 84, 2329–2335 (1999)CrossRefPubMedGoogle Scholar
  22. 22.
    H.R. Park, Y. Choi, H.J. Lee, J.Y. Oh, Y.S. Hong, Y.A. Sung, Phenotypic characteristics according to insulin sensitivity in non-obese Korean women with polycystic ovary syndrome. Diabetes Res. Clin. Pract. 77(Suppl 1), S233–S237 (2007)CrossRefPubMedGoogle Scholar
  23. 23.
    American Diabetes Association, Standards of medical care in diabetes—2007. Diabetes Care. 30(Suppl 1), S4–S41 (2007)CrossRefGoogle Scholar
  24. 24.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril. 81, 19–25 (2004)Google Scholar
  25. 25.
    J.Y. Oh, Y.S. Hong, Y.A. Sung, E. Barrett-Connor, Prevalence factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 27, 2027–2032 (2004)CrossRefPubMedGoogle Scholar
  26. 26.
    Steering Committee of the Western Pacific Region of the World Health Organization, the International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia Pty Limited, Melbourne, Australia, 2000Google Scholar
  27. 27.
    World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes and Mellitus. 1999Google Scholar
  28. 28.
    R.A. DeFronzo, J.D. Tobin, R. Andres, Glucose clamp technique: a method for quantifying insulin secretion, resistance. Am. J. Physiol. 237, E214–E223 (1979)PubMedGoogle Scholar
  29. 29.
    A. Tsujimura, K. Matsumiya, Y. Miyagawa, T. Takao, K. Fujita, S. Takada, M. Koga, A. Iwasa, M. Takeyama, A. Okuyama, Comparative study on evaluation methods for serum testosterone level for PADAM diagnosis. Int. J. Impot. Res. 17, 259–263 (2005)CrossRefPubMedGoogle Scholar
  30. 30.
    A. Vermeulen, L. Verdonck, J.M. Kaufman, A critical evaluation of simple methods for the estimation of free testosterone in serum. J. Clin. Endocrinol. Metab. 84, 3666–3672 (1999)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Hyejin Lee
    • 1
    Email author
  • Jee-Young Oh
    • 1
  • Yeon-Ah Sung
    • 1
  • Hyewon Chung
    • 2
  • Wha Young Cho
    • 3
  1. 1.Department of Internal Medicine, School of Medicine, Mokdong HospitalEwha Womans UniversitySeoulKorea
  2. 2.Department of Obstetrics and Gynecology, School of MedicineEwha Womans UniversitySeoulKorea
  3. 3.Department of Internal MedicineSeoul National University HospitalSeoulKorea

Personalised recommendations