From the Guidelines
Polycystic ovary syndrome (PCOS) and type 2 diabetes share a significant bidirectional relationship primarily connected through insulin resistance, with women with PCOS having a 5-10 times higher risk of developing type 2 diabetes compared to women without the condition. Insulin resistance affects 70-80% of women with PCOS, causing the pancreas to produce excess insulin to maintain normal blood sugar levels 1. This excess insulin stimulates the ovaries to produce more androgens (male hormones), worsening PCOS symptoms like irregular periods, acne, and excess hair growth. The relationship works both ways - the hormonal imbalances in PCOS can worsen insulin resistance, creating a cycle that increases diabetes risk. Common risk factors for both conditions include obesity, sedentary lifestyle, and genetic predisposition.
Management and Treatment
Management typically involves lifestyle modifications (weight loss, regular exercise, balanced diet) and medications like metformin (500-2000mg daily), which improves insulin sensitivity and can help regulate menstrual cycles 1. Other treatments may include birth control pills to regulate periods and reduce androgen levels, and specific diabetes medications if diabetes develops. Regular screening for diabetes is essential for women with PCOS, typically including fasting blood glucose tests and hemoglobin A1C measurements.
Key Considerations
It is essential to note that the association between obesity and PCOS is complex and bidirectional, with obesity genes noted on genetic studies in PCOS, and cluster analyses, alongside epidemiological and longitudinal studies, showing that obesity is increased in PCOS, is causal of PCOS, and exacerbates PCOS clinical features and as such is common in women with PCOS presenting to the clinic 1. Weight loss is recommended as part of management in individuals with PCOS with higher body mass index (BMI), with weight reduction shown to improve reproductive and metabolic consequences of PCOS.
Recent Guidelines and Recommendations
Recent guidelines, such as the 2023 International evidence-based guideline for the assessment and management of PCOS, recommend screening for dyslipidemia in all women with PCOS, and the use of anti-obesity pharmacological agents, such as glucagon-like peptide 1 receptor agonists (GLP-1 RAs), as an adjunct to lifestyle management for treatment of weight, hormonal and metabolic outcomes 1. The guideline also emphasizes the importance of lifestyle modification, including diet and exercise, in the management of PCOS.
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From the Research
Link between Diabetes Mellitus (DM) and Polycystic Ovary Syndrome (PCOS)
- Polycystic ovary syndrome (PCOS) is a complex endocrine condition that affects women of reproductive age and is characterized by insulin resistance, making it a major risk factor for type 2 diabetes mellitus (T2DM) 2, 3, 4.
- Studies have shown that women with PCOS have a higher risk of developing T2DM compared to those without PCOS, with an overall incidence of T2DM of 6.25 per 1000 person-years in the PCOS group compared to 1.49 in the control group 5.
- The risk of developing T2DM in women with PCOS is increased, regardless of their weight, with normal weight women with PCOS also being at risk 6.
- Insulin resistance and β-cell dysfunction are common in women with PCOS, and can lead to impaired glucose tolerance, which is an important metabolic and vascular risk marker in PCOS 2, 3, 4.
- Pharmacological interventions, such as metformin, acarbose, pioglitazone, and exenatide, have been shown to have significant effects on fasting blood glucose, fasting insulin, and homoeostatic model assessment of insulin resistance (HOMA-IR) in women with PCOS 3.
- The use of insulin-sensitizing medications, such as metformin, may be beneficial in treating ovarian hyperandrogenism and irregular ovulation in PCOS, and may also help to reduce the risk of T2DM and cardiovascular-related disease in women with PCOS 4.
Risk Factors for T2DM in PCOS
- Age: The risk of developing T2DM in women with PCOS decreases with increasing diagnosis age, with the highest risk seen in women diagnosed with PCOS at a young age 5.
- Weight: While obesity is a major risk factor for T2DM, normal weight women with PCOS are also at risk, and individual risk markers such as hyperandrogenism, age, and ethnicity should determine prospective screening programs 6.
- Hyperandrogenism: Hyperandrogenism is a common feature of PCOS and may contribute to the development of insulin resistance and T2DM 2, 4.
- Ethnicity: Women with PCOS of Asian ethnicity may be at higher risk of developing T2DM compared to women of other ethnicities 6.