PCOS a risk factor for diabetes irrespective of BMI: Prof Helena Teede

Prof. Helena Teede

The metabolic risk in PCOS is possibly underestimated prompting a reminder that healthy lifestyle interventions are recommended for all women with PCOS regardless of their BMI.

Writing in Fertility and Sterility, Professor Helena Teede and colleagues said the guideline recommendations, including for healthy eating and regular physical activity, is for both the prevention and treatment of obesity.

Professor Teede, an endocrinologist and Director of the Monash Centre for Health Research and Implementation, said clinicians continued to assume that the metabolic risks in PCOS were only driven by BMI, with a failure to recognise the intrinsic metabolic risk in PCOS.

“There is a need to raise awareness in women and clinicians around the metabolic and psychologic features of PCOS, which are both intrinsic and exacerbated in overweight and/or obese individuals. Clinicians should also be upskilled to support a healthy lifestyle in all women with PCOS,” she wrote.

The article was in response to a Korean study of 6,811 women 15-44 years from the National Health Insurance Service sample cohort.

The study found over a follow-up period of 144,831,677 person-years, the incidence rate of type 2 diabetes mellitus was 15.84/1,000 in women with PCOS and 5.80/1,000 person-years in the control group (p<.001).

The adjusted HR for developing diabetes was 2.355 in all women with PCOS compared to women without PCOS.

Importantly, a subgroup analysis showed that PCOS was significantly associated with an increased HR for type 2 diabetes women with and without obesity.

Obese women with PCOS had a higher risk for type 2 diabetes than obese women without PCOS (HR 2.847) and non-obese women without PCOS (HR 4.821).

Non-obese women with PCOS also had a HR of 2.334 for type 2 diabetes mellitus compared to non-obese women without PCOS.

The study also found the annual incidence of PCOS has increased significantly in the Korean population from 0.9 per 1,000 person-years in 2003 to 2.19 per 2,000 person-years in 2012.

It said the steady increase in obesity may promote the manifestation of PCOS phenotypes.

“Obesity has been assumed to be associated with a more prominent manifestation of both PCOS phenotypes and type 2 diabetes mellitus, rather than acting as a direct inducer of either condition,” the researchers said.

They said their findings suggests screening for type 2 diabetes mellitus should not be restricted to obese women with PCOS but be offered to women with a normal BMI and PCOS.

“Early screening and regular checkups for diabetes among women with PCOS would be helpful in preventing any long-term complications related to diabetes, such as cardiovascular risks,” the study said.

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