Medical Chronicle recently hosted a CPD-accredited webinar on polycystic ovarian syndrome (PCOS) and diabetes. This was the final webinar in the series on PCOS. It was sponsored by Lamelle Pharmaceuticals and was presented by Dr Bradley Wagemaker.  

To watch a replay of this webinar, and still earn a CPD point, click here: https://event.webinarjam.com/go/replay/635/9pqmpbg73iznnh3w0a7  

Polycystic ovary syndrome is a clinical syndrome typically characterised by anovulation or oligo-ovulation, signs of androgen excess (eg hirsutism, acne), and multiple ovarian cysts in the ovaries. Insulin resistance and obesity are often present.   

It is a chronic, endocrine-metabolic-reproductive condition affecting 5%-18% of women across their lifespans. Around 75% of women with PCOS exhibit insulin resistance (IR), linking PCOS with increased risk of Type 2 diabetes (T2D).   

Screening for glycaemic status  

When screening glycaemic status, we work on the following: 

• Fasting plasma glucose (FPG) 
• Not sufficiently sensitive to diagnose T2D or impaired glucose tolerance (IGT) in PCOS
• 20%-40% of IGT or T2D misclassified as normal glucose metabolism
• ADA and WHO values not in agreeance
• FG: 6.1-7mmol/L - OGTT. Glycated haemoglobin (HbA1c)
• ADA (5.7%) single value cut-off for T2D diagnosis.
• Unknown specificity in overweight and obese subjects (largest group in the PCOS population)
• ADA and WHO discordance (5.7% vs 6%) – confusion.

 Oral glucose tolerance test (OGTT): 

• Gold standard for T2D diagnosis
• Standardised
• ADA and WHO agree on diagnosis cut-off.
• >7.8mmol/L = IGT
• >11.1mmol/L = T2D.

PCOS is a heterogenous disorder. Assessment of phenotypes reveals varying risks and treatment requirements. Up to 70% of women with PCOS are insulin resistant with three times greater risk of developing T2D. The majority of PCOS women are overweight, worsening IR, metabolic syndrome and risk of T2D.  

KEY TAKEAWAYS 

• Hyperinsulinaemia is an independent risk factor for CVD, however no evidence for CVD event reduction.
• Treating the presumed sequelae of IR; metabolic syndrome, pre-diabetes or T2D is appropriate.
• Insulin resistance cannot be reliably diagnosed with fasting blood glucose
• Menopausal PCOS patients have a risk profile like their healthy counterparts (so far)
• Diet and exercise are the cornerstone of therapy in normo-glycaemic and pre/diabetic PCOS
• Metformin, inositol, thiazolidinediones (TZDs) and glucagon-like peptide-1 have been successfully used to manage dysglycaemia and T2D and in PCOS
• Inositol has been shown to also reduce gestational diabetes mellitus in PCOS and healthy women at risk, as well as the metabolic syndrome.