Polycystic Ovarian Syndrome and Risk of Type 2 Diabetes
It is generally accepted that insulin dysregulation is a major contributor to polycystic ovary syndrome (PCOS). Insulin acts by shunting more precursor hormones over to testosterone instead of estrogen. These elevated levels of testesterone then lead to the findings of PCOS. The authors suggest an insulin to glucose ratio to determine whether insulin resistance is present; this is one of the most accurate ways to identify impaired glucose tolerance decades before diabetes may develop.
J Pediatr 2001;138:38-44 Profound metabolic derangements, which can be detected early in young, obese adolescent girls with polycystic ovarian syndrome, appear to increase the risk of type 2 diabetes mellitus, report physicians in Pennsylvania. Dr. Silva Arslanian and colleagues, of the Children’s Hospital of Pittsburgh, determined in vivo insulin sensitivity, insulin secretion, and fasting hepatic glucose production in 22 girls, average age 12.0 years, whose body mass index was 90% or greater for their age. Twelve subjects had been diagnosed with polycystic ovarian syndrome after exhibiting hyperandrogenism, while the remaining 10 girls served as controls. Fasting glucose levels were normal in all subjects, the investigators report in the January issue of the Journal of Pediatrics. Hepatic glucose production was also similar between the two groups. However, among the girls with the ovarian syndrome, fasting insulin levels were about twice as high, while insulinlike growth factor binding protein-1 and fasting glucose-to-insulin ratios were lower, compared with those in the control subjects. Dr. Arslanian and associates conclude that the reduction in peripheral tissue insulin sensitivity, hepatic insulin resistance, and compensatory hyperinsulinemia puts obese adolescents with polycystic ovarian syndrome at risk for type 2 diabetes. The investigators recommend oral glucose tolerance testing in patients with this syndrome and suggest that the fasting glucose-to-insulin ratio may be of use in screening for insulin resistance.