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Prevalence of polycystic ovary syndrome and its clinical and hormonal profile in young females with type 1 diabetes mellitus: experience from a teaching institution of India

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Abstract

Objective

To investigate the prevalence of polycystic ovary syndrome and its clinical and hormonal profile in females with type 1 diabetes.

Materials and methods

65 T1DM females were evaluated for presence of PCOS by Rotterdam ESHRE/ASRM consensus criteria and compared with age and BMI matched females with PCOS without diabetes and females with T1DM without PCOS.

Results

According to Rotterdam criteria 18/65 (27%) had PCOS. Prevalence of androgen excess, hirsutism, menstrual dysfunction and PCOM was 26%, 3%, 21% and 52%, respectively. Females with T1DM who had PCOS did not differ from females with T1DM without PCOS. When the group of T1DM with PCOS was compared with PCOS females without diabetes, they had significantly lower hirsutism score (median, IQR; 1.5, 0–3 vs. 11.5, 0–16.5, p = 0.04), significantly higher waist hip ratio (0.91, 0.89–0.99 vs. 0.86, 0.80–0.89, p = 0.004) and SHBG (in nmol, 54.4, 38–86.2 vs. 28.3, 20.4–37.4, p = 0.004).

Conclusion

Females with T1DM have a high prevalence of menstrual abnormalities, hyperandrogenism and PCOS which is not related to metabolic control, age of onset of diabetes or insulin dose. Polycystic ovary syndrome, hyperandrogenism, type 1 diabetes, menstrual irregularity, hirsutism.

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References

  1. M.A. Atkinson, G.S. Eisenbarth, A.W. Michels, Type 1 diabetes. Lancet 383(9911), 69–82 (2014). https://doi.org/10.1016/S0140-6736(13)60591-7

    Article  PubMed  Google Scholar 

  2. https://www.diabetesatlas.org/data/en/country/93/in.html Accessed 16th July 2022

  3. C.J. Adcock, L.A. Perry, D.R. Lindsell, A.M. Taylor, J.M. Holly, J. Jones, D.B. Dunger, Menstrual irregularities are more common in adolescents with type 1 diabetes: association with poor glycaemic control and weight gain. Diabet. Med. J. Br. Diabet. Assoc. 11(5), 465–470 (1994). https://doi.org/10.1111/j.1464-5491.1994.tb00307.x

    Article  CAS  Google Scholar 

  4. H.F. Escobar-Morreale, B. Roldán, R. Barrio, M. Alonso, J. Sancho, H. de la Calle, R. García-Robles, High prevalence of the polycystic ovary syndrome and hirsutism in women with type 1 diabetes mellitus. J. Clin. Endocrinol. Metab. 85(11), 4182–4187 (2000). https://doi.org/10.1210/jcem.85.11.6931

    Article  CAS  PubMed  Google Scholar 

  5. E. Codner, N. Soto, P. Lopez, L. Trejo, A. Avila, F.C. Eyzaguirre, G. Iniguez, F. Cassorla, Diagnostic criteria for polycystic ovary syndrome and ovarian morphology in women with type 1 diabetes mellitus. J. Clin. Endocrinol. Metab. 91(6), 2250–2256 (2006). https://doi.org/10.1210/jc.2006-0108

    Article  CAS  PubMed  Google Scholar 

  6. X. Gaete, M. Vivanco, F.C. Eyzaguirre, P. López, H.K. Rhumie, N. Unanue, E. Codner, Menstrual cycle irregularities and their relationship with HbA1c and insulin dose in adolescents with type 1 diabetes mellitus. Fertil. Steril. 94(5), 1822–1826 (2010). https://doi.org/10.1016/j.fertnstert.2009.08.039

    Article  CAS  PubMed  Google Scholar 

  7. A. Miyoshi, S. Nagai, M. Takeda, T. Kondo, H. Nomoto, H. Kameda, A. Hirai, K. Cho, K. Kimachi, C. Shimizu, T. Atsumi, H. Miyoshi, Ovarian morphology and prevalence of polycystic ovary syndrome in Japanese women with type 1 diabetes mellitus. J. Diabetes Investig. 4(3), 326–329 (2013). https://doi.org/10.1111/jdi.12040

    Article  PubMed  PubMed Central  Google Scholar 

  8. A. Zachurzok, G. Deja, A. Gawlik, A. Drosdzol-Cop, E. Małecka-Tendera, Hyperandrogenism in adolescent girls with type 1 diabetes mellitus treated with intensive and continuous subcutaneous insulin therapy. Endokrynologia Pol. 64(2), 121–128 (2013)

    CAS  Google Scholar 

  9. M.C. Amato, V. Guarnotta, A. Ciresi, R. Modica, F. Panto, C. Giordano, No phenotypic differences for polycystic ovary syndrome (PCOS) between women with and without type 1 diabetes mellitus. J. Clin. Endocrinol. Metab. 99(1), 203–211 (2014). https://doi.org/10.1210/jc.2013-2669

    Article  CAS  PubMed  Google Scholar 

  10. C. Reinauer, E. Bollow, E. Fröhlich-Reiterer, K. Laubner, D. Bergis, C. Schöfl, H.P. Kempe, M. Hummel, P. Hennes, K. Gollisch et al. Polycystic Ovary Syndrome (PCOS) in juvenile and adult type 1 diabetes in a German/Austrian cohort. Exp. Clin. Endocrinol. Diabetes 125(10), 661–668 (2017). https://doi.org/10.1055/s-0043-104701

    Article  CAS  PubMed  Google Scholar 

  11. K. Busiah, A. Colmenares, M. Bidet, N. Tubiana-Rufi, C. Levy-Marchal, C. Delcroix, P. Jacquin, D. Martin, L. Benadjaoud, E. Jacqz-Aigrain et al. High prevalence of polycystic ovary syndrome in type 1 diabetes mellitus adolescents: is there a difference depending on the NIH and Rotterdam criteria. Horm. Res. Paediatr 87(5), 333–341 (2017). https://doi.org/10.1159/000471805

    Article  CAS  PubMed  Google Scholar 

  12. S.A. Paschou, A. Vryonidou, M. Melissourgou, I. Kosteria, D. Goulis, G.P. Chrousos, C. Kanaka-Gantenbein, Menstrual disorders and androgen-related traits in young women with type 1 diabetes mellitus: a clinical study. Endocr. Pract. 26(11), 1269–1276 (2020). https://doi.org/10.4158/EP-2020-0153

    Article  PubMed  Google Scholar 

  13. E.P. Thong, F. Milat, A.E. Joham, G.D. Mishra, H. Teede, Obesity, menstrual irregularity and polycystic ovary syndrome in young women with type 1 diabetes: a population-based study. Clin. Endocrinol. 93(5), 564–571 (2020). https://doi.org/10.1111/cen.14281

    Article  CAS  Google Scholar 

  14. M.U. Halldin, L. Hagenäs, T. Tuvemo, J. Gustafsson, Profound changes in the GH-IGF-I system in adolescent girls with IDDM: can IGFBP1 be used to reflect overall glucose regulation? Pediatr. Diabetes 1(3), 121–130 (2000). https://doi.org/10.1034/j.1399-5448.2000.010302.x

    Article  CAS  PubMed  Google Scholar 

  15. V. De Leo, A. la Marca, F. Petraglia, Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr. Rev. 24(5), 633–667 (2003). https://doi.org/10.1210/er.2002-0015

    Article  CAS  PubMed  Google Scholar 

  16. J.E. Nestler, C.O. Barlascini, D.W. Matt, K.A. Steingold, S.R. Plymate, J.N. Clore, W.G. Blackard, Suppression of serum insulin by diazoxide reduces serum testosterone levels in obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 68(6), 1027–1032 (1989). https://doi.org/10.1210/jcem-68-6-1027

    Article  CAS  PubMed  Google Scholar 

  17. A. Gambineri, L. Patton, R. De Iasio, B. Cantelli, G.E. Cognini, M. Filicori, A. Barreca, E. Diamanti-Kandarakis, U. Pagotto, R. Pasquali, Efficacy of octreotide-LAR in dieting women with abdominal obesity and polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 90(7), 3854–3862 (2005). https://doi.org/10.1210/jc.2004-2490

    Article  CAS  PubMed  Google Scholar 

  18. L. Rossetti, A. Giaccari, R.A. DeFronzo, Glucose toxicity. Diabetes Care 13(6), 610–630 (1990). https://doi.org/10.2337/diacare.13.6.610

    Article  CAS  PubMed  Google Scholar 

  19. M.L. Ahmed, K.K. Ong, A.P. Watts, D.J. Morrell, M.A. Preece, D.B. Dunger, Elevated leptin levels are associated with excess gains in fat mass in girls, but not boys, with type 1 diabetes: longitudinal study during adolescence. J. Clin. Endocrinol. Metab. 86(3), 1188–1193 (2001). https://doi.org/10.1210/jcem.86.3.7320

    Article  CAS  PubMed  Google Scholar 

  20. E. Codner, A. Barrera, D. Mook-Kanamori, R.A. Bazaes, N. Unanue, X. Gaete, A. Avila, F. Ugarte, I. Torrealba, V. Pérez, E. Panteón, F. Cassorla, Ponderal gain, waist-to-hip ratio, and pubertal development in girls with type-1 diabetes mellitus. Pediatr. Diabetes 5(4), 182–189 (2004). https://doi.org/10.1111/j.1399-543X.2004.00059.x

    Article  PubMed  Google Scholar 

  21. P. Fellinger, D. Fuchs, P. Wolf et al. Overweight and obesity in type 1 diabetes equal those of the general population. Wien. Klin. Wochenschr. 131(3-4), 55–60 (2019). https://doi.org/10.1007/s00508-018-1434-9

    Article  PubMed  PubMed Central  Google Scholar 

  22. F. Ramezani Tehrani, M. Amiri, S. Behboudi-Gandevani, R. Bidhendi-Yarandi, E. Carmina, Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis. Gynecol. Endocrinol. 36(1), 12–23 (2020). https://doi.org/10.1080/09513590.2019.1650337

    Article  PubMed  Google Scholar 

  23. T.R. Berni, C.L. Morgan, D.A. Rees, Women with polycystic ovary syndrome have an increased risk of major cardiovascular events: a population study. J. Clin. Endocrinol. Metab. 106(9), e3369–e3380 (2021). https://doi.org/10.1210/clinem/dgab392

    Article  PubMed  PubMed Central  Google Scholar 

  24. A. Hajra, Y. Li, S. Siu, N. Udaltsova, M.A. Armstrong, G.D. Friedman, A.L. Klatsky, Risk of coronary disease in the South Asian American population. J. Am. Coll. Cardiol. 62(7), 644–645 (2013). https://doi.org/10.1016/j.jacc.2013.05.048

    Article  PubMed  Google Scholar 

  25. D.K. Arnett, R.S. Blumenthal, M.A. Albert, A.B. Buroker, Z.D. Goldberger, E.J. Hahn, C.D. Himmelfarb, A. Khera, D. Lloyd-Jones, J.W. McEvoy, E.D. Michos, M.D. Miedema, D. Muñoz, S.C. Smith Jr, S.S. Virani, K.A. Williams, J. Sr, Yeboah, B. Ziaeian, 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 140(11), e596e646 (2019). https://doi.org/10.1161/CIR.0000000000000678

    Article  Google Scholar 

  26. R.S. Legro, S.A. Arslanian, D.A. Ehrmann, K.M. Hoeger, M.H. Murad, R. Pasquali, C.K. Welt; Endocrine Society, Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 98(12), 4565–4592 (2013). https://doi.org/10.1210/jc.2013-2350

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. D. Ferriman, J.D. Gallwey, Clinical assessment of body hair growth in women. J. Clin. Endocrinol. Metab. 21, 1440–1447 (1961). https://doi.org/10.1210/jcem-21-11-1440

    Article  CAS  PubMed  Google Scholar 

  28. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril. 81(1), 19–25 (2004). https://doi.org/10.1016/j.fertnstert.2003.10.004

    Article  Google Scholar 

  29. D. Lizneva, L. Suturina, W. Walker, S. Brakta, L. Gavrilova-Jordan, R. Azziz, Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil. Steril. 106(1), 6–15 (2016). https://doi.org/10.1016/j.fertnstert.2016.05.003

    Article  PubMed  Google Scholar 

  30. Zawadski, J.K. and Dunaif, A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. in Polycystic Ovary Syndrome, ed. by A. Dunaif, J.R. Givens, and F. Haseltine (Blackwell Scientific, Boston, 1992) pp. 377–384

  31. R. Azziz, E. Carmina, D. Dewailly, E. Diamanti-Kandarakis, H.F. Escobar-Morreale, W. Futterweit, O.E. Janssen, R.S. Legro, R.J. Norman, A.E. Taylor et al.; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society, The androgen excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil. Steril. 91(2), 456–488 (2009). https://doi.org/10.1016/j.fertnstert.2008.06.035

    Article  PubMed  Google Scholar 

  32. M.A. Ganie, V. Vasudevan, I.A. Wani, M.S. Baba, T. Arif, A. Rashid, Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian J. Med. Res. 150(4), 333–344 (2019). https://doi.org/10.4103/ijmr.IJMR_1937_17

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. W.M. Wolf, R.A. Wattick, O.N. Kinkade, M.D. Olfert, Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J. Environ. Res Public Health 15(Nov 11), 2589 (2018). https://doi.org/10.3390/ijerph15112589

    Article  PubMed  PubMed Central  Google Scholar 

  34. R. Mazumder, D. Sarkar, B.R. Chowdhury, U.R. Chowdhury, S. Chowdhury, Clinical assessment of obesity and insulin resistance in type 1 diabetes subjects seen at a center in Kolkata. J. Assoc. Physicians India 57, 511–514 (2009)

    PubMed  Google Scholar 

  35. H.F. Escobar-Morreale, M.B. Roldán-Martín, Type 1 diabetes and polycystic ovary syndrome: systematic review and meta-analysis. Diabetes Care 39(4), 639–648 (2016). https://doi.org/10.2337/dc15-2577

    Article  CAS  PubMed  Google Scholar 

  36. E. Codner, H.F. Escobar-Morreale, Clinical review: Hyperandrogenism and polycystic ovary syndrome in women with type 1 diabetes mellitus. J. Clin. Endocrinol. Metab. 92(4), 1209–1216 (2007). https://doi.org/10.1210/jc.2006-2641

    Article  CAS  PubMed  Google Scholar 

  37. E. Codner, G. Iñiguez, I.M. Hernández, P. Lopez, H.K. Rhumie, C. Villarroel, R.A. Rey, Elevated anti-Müllerian hormone (AMH) and inhibin B levels in prepubertal girls with type 1 diabetes mellitus. Clin. Endocrinol. 74(1), 73–78 (2011). https://doi.org/10.1111/j.1365-2265.2010.03887.x

    Article  CAS  Google Scholar 

  38. A. Łebkowska, A. Adamska, A. Krentowska, A. Uruska, A. Rogowicz-Frontczak, A. Araszkiewicz, K. Ożegowska, J. Hryniewicka, M. Leśniewska, E. Wender-Ożegowska, D. Zozulińska-Ziółkiewicz, I. Kowalska, The influence of prepubertal onset of type 1 diabetes and age of menarche on polycystic ovary syndrome diagnosis. J. Clin. Endocrinol. Metab. 106(6), 1811–1820 (2021). https://doi.org/10.1210/clinem/dgab062

    Article  PubMed  Google Scholar 

  39. B. Roldán, H.F. Escobar-Morreale, R. Barrio, H. de La Calle, M. Alonso, R. García-Robles, J. Sancho, Identification of the source of androgen excess in hyperandrogenic type 1 diabetic patients. Diabetes Care 24(7), 1297–1299 (2001). https://doi.org/10.2337/diacare.24.7.1297

    Article  PubMed  Google Scholar 

  40. R. Amin, C. Schultz, K. Ong, J. Frystyk, R.N. Dalton, L. Perry, H. Ørskov, D.B. Dunger; Oxford Regional Prospective Study, Low IGF-I and elevated testosterone during puberty in subjects with type 1 diabetes developing microalbuminuria in comparison to normoalbuminuric control subjects: the Oxford Regional Prospective Study. Diabetes Care 26(5), 1456–1461 (2003). https://doi.org/10.2337/diacare.26.5.1456

    Article  CAS  PubMed  Google Scholar 

  41. Y.H. Cho, M.E. Craig, S. Srinivasan, P. Benitez-Aguirre, P. Mitchell, T. Jopling, K.C. Donaghue, Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycaemic control, insulin resistance and hyperandrogenism. Clin. Endocrinol. 80(6), 818–824 (2014). https://doi.org/10.1111/cen.12238

    Article  CAS  Google Scholar 

  42. H. Gill, P. Tiwari, P. Dabadghao, Prevalence of polycystic ovary syndrome in young women from North India: a Community-based study. Indian J. Endocrinol. Metab. 16(Suppl 2), S389–S392 (2012). https://doi.org/10.4103/2230-8210.104104

    Article  PubMed  PubMed Central  Google Scholar 

  43. C. Snehalatha, V. Viswanathan, A. Ramachandran, Cutoff values for normal anthropometric variables in asian Indian adults. Diabetes Care 26(5), 1380–1384 (2003). https://doi.org/10.2337/diacare.26.5.1380

    Article  PubMed  Google Scholar 

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Funding

Intramural academic grant from author’s institute (Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India). Grant no.- PGI/DIR/R.C./205/2015.

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Author notes

  1. These authors contributed equally: Nibu Dominic, Lokesh Sharma

Authors and Affiliations

  1. Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Nibu Dominic, Lokesh Sharma & Preeti Dabadghao

  2. Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Namita Mohindra

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Contributions

P.D. conceptualised, and planned the study, contributed to data analysis and in editing and finalising the manuscript. N.D. planned the study, did literature search, data collection and data analysis and wrote the manuscript. N.M. planned the study, did ultrasonography of all the patients, did data collection, wrote, and edited the manuscript. L.S. did literature search and data analysis, and wrote and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Preeti Dabadghao.

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Conflict of interest

The authors declare no competing interests.

Ethics approval

The study was approved by the Institutional Ethics Committee and adheres to the guidelines of Helsinki declaration (IEC code 2014-201-DM-EXP numbered PGI/BE/898/2014).

Consent

At the time of recruitment all subjects signed an informed consent and in case of minors, informed consent was taken from caregivers along with assent from the subjects for participation and publication of their data.

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Annexure 1

Annexure 1

Assays

Biochemical analyses were done on the same day, by autoanalyzer (RX imola, Randox labs, UK). Serum levels of FSH, LH, prolactin, TSH and SHBG were estimated with chemiluminescence analyser (Immulite 1000, Siemens, Tarrytown, NY). Serum testosterone, DHEAS and 17- OH progesterone were measured by radioimmunoassay (Immunotech, Beckman Coulter, Marseille, France). Analytical sensitivity, intra-assay and inter-assay coefficient of variation (CV) were 0.069 nmo/L, 5.6% and 15%, and 0.072 µmol/L, 4.93% and 9.32%, respectively for testosterone and DHEAS assays. Glycosylated haemoglobin level was measured with cation exchange high performance liquid chromatography (BIO-RAD VARIANT II, California, USA).

Free androgen index (FAI) was calculated as the ratio of testosterone to SHBG (both in nmol/l) multiplied by 100. Biochemical hyperandrogenism was defined as: total testosterone ≥1.7 nmo/l or DHEAS ≥ 8 μmol/L (calculated on the basis of the 95th percentile of basal serum androgen concentrations in 97 girls aged between 18 and 25 years with normal menstrual cycles and no features of hyperandrogenism used as a control group in a previous study of same population) [42].

Anthropometric measurements:

Anthropometric measurements included weight, height, waist circumference (WC, measured at the midpoint between the lateral iliac crest and lower rib margin at the end of normal expiration), waist to hip ratio (WHR), with hip measured at the widest level of the greater trochanters with minimal clothing.

We have used WHR norms from an Indian study [43]. In this study authors concluded cut-off of normal WHR as 0.81 and 0.88 for women and men, respectively.

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Dominic, N., Sharma, L., Mohindra, N. et al. Prevalence of polycystic ovary syndrome and its clinical and hormonal profile in young females with type 1 diabetes mellitus: experience from a teaching institution of India. Endocrine 82, 303–310 (2023). https://doi.org/10.1007/s12020-023-03470-z

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