Polycystic Ovary Syndrome in Premenopausal Women with Type 2 Diabetes Mellitus: Prevalence, Characters and Related Morbidity

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous condition characterized by anovulation, hyperandrogenism, and metabolic derangements including insulin resistance and dyslipidaemia. Both PCOS and type 2 DM are linked through insulin resistance. Women with PCOS are, therefore at higher risk of type 2 DM. Aim of the Work: The present study was conducted to investigate the prevalence of PCOS in premenopausal women with type 2 diabetes mellitus. Setting: Diabetes clinic in Kasr Al Aini teaching hospital. Gynaecological assessment was conducted in the gynaecology clinic of Kasr al Aini teaching hospital, Cairo university. Patients and Methods: This is a cross-sectional study. Type 2 diabetic women of reproductive age who were either on oral hypoglycemic drugs or diet control were included in the study. Baseline demographic characteristics were obtained and body mass index, waist/hip ratio and F/G scores were determined. PCOS was initially diagnosed using the criteria proposed by the Androgen Excess and PCOS Society (AEPS). Laboratory investigations included hormonal and lipid profiles. The main outcome measure was prevalence of PCOS calculated according to AEPS criteria. Reanalysis of data and recalculation of the prevalence rate according to the Rotterdam and NIH criteria was also done. Results: Seventy one diabetic women enrolled in the study. Nine (12.68%) had clinical symptoms of PCOS according to the AEPS criteria. The prevalence rate of PCOS in women with type 2 DM according to the Rotterdam criteria was also 12.68%. According to the NIH criteria the observed prevalence rate was 9.86%. The mean age of subjects with PCOS at diagnosis of DM was significantly lower than that of non-PCOS diabetics (33.89 ±3.55 Vs 39.84±2.68 years, p= <0.0001). Diabetics with PCOS had significantly higher BMI and WHR than diabetics without PCOS (32.73 ±2.67 versus 30.48± 1.92, p=0.017 and 0.895±0.036 versus 0.865 ±0.031, p=0.015, respectively). The incidence of gestational diabetes and stillbirths was not significantly different between the two groups. Both PCOSand non-PCOS diabetics reported a high incidence of family history of DM, however there was no significant difference between the two groups. No difference in lipid profile, was observed between the two groups. Conclusion: The prevalence of PCOS in diabetic women is not higher than the general population. Hyperandrogenic women with PCOS show the highest risk of developing DM. Patients with PCOS are at risk of developing type 2 DM at a younger age than non PCOS diabetics. Obesity, especially abdominal obesity, is an important risk factor for developing DM in women with PCOS.