Elsevier

Endocrine Practice

Volume 20, Issue 9, September 2014, Pages 855-863
Endocrine Practice

Original Article
Practice Patterns in Screening for Metabolic Disease in Women with PCOS of Diverse Race-Ethnic Backgrounds

https://doi.org/10.4158/EP13414.ORGet rights and content

ABSTRACT

Objectives

Women with polycystic ovary syndrome (PCOS) are at high risk for metabolic disorders, which prompted the American Association of Clinical Endocrinologists (AACE) to publish a 2005 position statement recommending screening for metabolic disease.

The purposes of the present study were to 1) to examine changes in screening rates for obesity, type 2 diabetes (T2D), metabolic syndrome (MetS), hyperlipidemia (HL), nonalcoholic fatty liver disease (NAFLD), and hypertension (HTN) in women with PCOS after publication of the 2005 AACE position statement and 2) to determine if screening rates and metabolic disorders vary by race-ethnicity.

Methods

PCOS cases in 2006 (n = 547) and 2011 (n = 1,159) and metabolic disorders were identified by International Classification of Diseases, 9th revision (ICD9) code. Screening rates for metabolic disorders were determined by the presence of blood tests (hemoglobin A1c [HbA1c], lipid profile, alanine aminotransferase/aspartate aminotransferase [ALT/AST]).

Results

In 2006, ≤ 25% of PCOS patients underwent recommended screening tests: HbA1c 18%; lipid profile < 20%; ALT/AST ≤ 25%. By 2011, only HbA1c testing had increased (18% to 21%). Obesity increased from 35% to 40%, while other metabolic disorders remained stable. Black women had the highest rates of obesity and HTN in 2011 (Obesity: Black 48%, Hispanic 44%, White 33%, Other 31%, P < .0001; HTN: Black 18%, Hispanic 9%, White 10%, Other 7%, P < .0001). Blacks and Hispanics were screened more often with ALT/AST testing (Black 27/27%, Hispanic 28/27%, White 23/22%, Other 17/18%, P = .02/.03). Screening rates were higher in the endocrine clinic for all metabolic disorders than in other clinics (P < .05).

Conclusion

Despite the publication of recommendations in 2005, screening rates for metabolic disease in women with PCOS remained low across all race-ethnicities in 2011. (Endocr Pract. 2014;20:855-863)

Section snippets

INTRODUCTION

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women affecting an estimated 8 to 10% (1), with estimates as high as 18% in some populations (2). PCOS presents with a variety of phenotypes due to complex interactions between environmental and genetic influences. Furthermore, presentation may differ across the reproductive lifespan (3). As a result, the formal diagnosis has remained controversial, with 3 different proposed diagnostic criteria: the 1990

METHODS

This study protocol was approved by the BUMC Institutional Review Board. De-identified data for patients evaluated in this study were extracted from the BUMC clinical database, which is built from the electronic medical record (EMR). Cases of PCOS were identified by International Classification of Diseases, 9th revision (ICD9) code 256.4 on the problem list between January 1, 2006 and December 31, 2011. The presence of metabolic disease (obesity, MetS, T2D, hyperlipidemia [HL], NAFLD, and

RESULTS

From 2006 to 2011, the number of PCOS cases seen in BUMC ambulatory clinics doubled from 547 (Black: n = 194, Hispanic: n = 87, White: n = 156, Other: n = 110) to 1,159 (Black: n = 393, Hispanic: n = 184, White: n = 325, Other: n = 257); the overall number of women aged 18 to 50 seen in BUMC ambulatory clinics was 8,491 in 2006 and 23,811 in 2011. Women with PCOS in both 2006 and 2011 were generally young with high rates of obesity (Table 1). Racial-ethnic differences in characteristics were

DISCUSSION

Women with PCOS have an increased risk of metabolic disorders, particularly obesity, insulin resistance, and T2D, with onset at earlier ages than women without PCOS (3). As a result, women diagnosed with PCOS need comprehensive evaluation for metabolic disorders. To our knowledge, this is one of the first studies to assess if screening recommendations for metabolic disorders in women with PCOS are being followed. Approximately 75% of women did not receive the recommended laboratory metabolic

CONCLUSION

PCOS is the most common endocrine disorder in premenopausal women (8-10%) (1). Reducing rates of obesity, diabetes, and CVD in women with PCOS would help reduce the substantial chronic health burden these women face, as well as the associated financial cost to the healthcare system (37). To our knowledge, this is the first study to assess if screening recommendations for metabolic disorders in women with PCOS are being followed after the comprehensive position statement published by AACE in

DISCLOSURE

The authors have no multiplicity of interest to disclose.

ACKNOWLEDGMENTS

The authors wish to thank Linda Rosen, Director of the BUMC Clinical Database Warehouse, for extracting and collating the clinical data for this project and Nicole L. Glazer, PhD, for her assistance with data preparation. This project was supported in part by the following: Robert Dawson Evans Junior Faculty Merit Award (ADC), RO1-HL094755 (ADC), NIH-CTSI UL1RR25771 (ADC). A portion of the data presented in this manuscript was presented in abstract form at the 95th Annual Meeting of the

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    Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on March 18, 2014. DOI:10.4158/EP13414.OR

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