Abnormal Glucose Metabolism in Patients with PCOS: Comparison between OGTT and HbA1c

Bilal Natiq Nuaman^1, , Mahmood Shakir Khudhair², Mohammed Sami Turki³ and Sanad Asaad Abd Al-Hussein⁴

¹Board certified Consultant Internist, Endocrinologist and Assistant Professor at Al-Iraqia University

²Board certified Professor and consultant of Internal Medicine and Endocrinology-Al-Nahrain University

³Board certified Specialist Endocrinologist, Al-Mirjan Medical City

⁴Board certified Specialist Endocrinologist at Al-Najaf Center for Diabetes and Endocrinology

Cite this paper:
Bilal Natiq Nuaman, Mahmood Shakir Khudhair, Mohammed Sami Turki and Sanad Asaad Abd Al-Hussein. Abnormal Glucose Metabolism in Patients with PCOS: Comparison between OGTT and HbA1c. American Journal of Medicine Studies. 2026; 11(1):1-7. doi: 10.12691/ajms-11-1-1

Abstract

Introduction: Polycystic ovarian syndrome is one of the most common Endocrine disorders affecting women and is associated with a raised risk of impaired glucose tolerance, impaired fasting glucose, and type 2 diabetes mellitus. Insulin resistances, and the development of compensatory hyperinsulinemia, are usual findings in polycystic ovarian syndrome. Aims: To Compare the diagnosis of diabetes mellitus in patients with polycystic ovarian syndrome (PCOS) using glycated hemoglobin (HbA1c) and OGTT in a sample of Iraqi ladies with PCOS. Methods: This is a cross section study enrolled 40 patients female with PCOS, The patients were tested for OGTT, HbA1c and fasting blood glucose Was carried out at the endocrinological outpatient department of al Imamein Kadhimein medical city Teaching Hospital, and National diabetes center. Results: The present study included 40 diagnosed patients with PCOS. The mean age of the patients at presentation was 30.95±9.63years (range 16-44 years). According to 2h-OGTT, 28 (70%) women had normal glucose level. Among those, only 24 were also normal according to HbA1c, and 16 normal according to FPG. Impaired glucose tolerance was reported in 9 patients. 3 women (7.5%) were considered to have diabetes according to 2h-OGTT, all of whom were detected as normal in both HbA1c and FPG. Receiver operating characteristic was used to evaluate the predictive value of HbA1c in predicating IGT. The test's sensitivity and specificity were 77% and 65%, respectively. Conclusions: T2DM and prediabetes common in PCOS patient, and when compared with the 2-hr OGTT, HbA1c is insufficient screening tool for prediabetes and T2DM screening in female with PCOS

Keywords:
dysglycemia PCOS HBA1C PRE DM IR

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, Pfeifer M, Pignatelli D, Pugeat M, Yildiz BO; ESE PCOS Special Interest Group. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2019; 171: P1-29.
[2]	Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, Lizneva D, Natterson-Horowtiz B, Teede HJ, Yildiz BO. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2: 16057.
[3]	Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J ClinEndocrinolMetab. 2020;87(3):1017–23.
[4]	Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod 2016; 31: 2619-2631.
[5]	Zhu T, Cui J, Goodarzi MO. Polycystic Ovary Syndrome and Risk of Type 2 Diabetes, Coronary Heart Disease, and Stroke. Diabetes 2021; 70: 627-637.
[6]	Dapas M, Lin FTJ, Nadkarni GN, Sisk R, Legro RS, Urbanek M, Hayes MG, Dunaif A. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLoS Med 2020; 17: e1003132.
[7]	Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2006; 295: 1288–1299.
[8]	Oh JY, Barrett-Connor E, Wedick NM, Wingard DL Rancho Bernardo Study. Endogenous sex hormones and the development of type 2 diabetes in older men and women: The Rancho Bernardo study. Diabetes Care. 2019; 25: 55–60.
[9]	Muka T, Nano J, Jaspers L, Meun C, Bramer WM, Hofman A, Dehghan A, Kavousi M, Laven JS, Franco OH. Associations of Steroid Sex Hormones and Sex Hormone-Binding Globulin with the Risk of Type 2 Diabetes in Women: A Population-Based Cohort Study and Meta-analysis. Diabetes. 2017; 66: 577–586.
[10]	Cotrozzi G, Matteini M, Relli P, Lazzari T. Hyperinsulinism and insulin resistance in polycystic ovarian syndrome: a verification using oral glucose, I.V. Glucose and tolbutamide. ActaDiabetol Lat. 2013; 20: 135–142.
[11]	The Rotterdam ESHRE/ASRM-Sponsored consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related topolycysticovary syndrome(PCOS). HumReprod2020; 19: 41–47.
[12]	Wild RA CE, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J ClinEndocrinolMetab 2018; 95: 2038–2049.
[13]	Wehr E, Gruber HJ, Giuliani A, Mo¨ller R, Pieber TR, Obermayer-Pietsch B. The lipid accumulation product is associated with impaired glucose tolerance in PCOS women. J Clin Endocrinol Metab 2011; 96: E986–E990.
[14]	Lillioja S, Mott DM, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. J ClinEndocrinolMetab 2017; 329: 1988–1992.
[15]	Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr. Diabetes 2017; 36: 523–534.
[16]	Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 2019; 22: 141–146.
[17]	Celik C, Abali R, Bastu E, Tasdemir N, Tasdemir UG, Gul A. Assessment of impaired glucose tolerance prevalence with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study. Hum Reprod 2013; 28: 1062–1068.
[18]	Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care. 2021; 34: 518–523.
[19]	American Diabetes A. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43 (Suppl 1): S14-31
[20]	Mortada R, Comerford K, Kallail KJ, Karakas SE. Utility of hemoglobin-A1C in nondiabetic women with polycystic ovary syndrome. EndocrPract. 2013; 19: 284-9.
[21]	de Medeiros SF, Yamamoto MM, Bueno HB, Belizario D, Barbosa JS. Prevalence of elevated glycated hemoglobin concentrations in the polycystic ovary syndrome: anthropometrical and metabolic relationship in amazonian women. J Clin Med Res. 2014; 6: 278-86.
[22]	Van Leiden H, Dekker J, Moll A. Risk factors for incident retinopathy in a diabetic and non-diabetic population: the Hoorn study. Arch Ophthalmol. 2018; 121: 245–251.
[23]	The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009; 32: 1327–1334
[24]	Pesant MH, Baillargeon JP. Clinically useful predictors of conversion to abnormal glucose tolerance in women with polycystic ovary syndrome. FertilSteril 2011; 95: 210-215.
[25]	Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 2018; 16: 1995-1998.
[26]	Solomon A, Hussein M, Negash M, Ahmed A, Bekele F, Kahase D. Effect of iron deficiency anemia on HbA1c in diabetic patients at TikurAnbessa specialized teaching hospital, Addis Ababa Ethiopia. BMC Hematol 2019; 19: 2.
[27]	American Diabetes Association. Standards of medical care in diabetes— 2020. Diabetes Care 2020;36: S11–S66.
[28]	LegroRS, KunselmanAR, DodsonWC, DunaifA. Prevalence and predictorsof risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J ClinEndocrinolMetab 2018; 84: 165–169.
[29]	Rotterdam EA-SPCWG. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. FertilSteril. 2019; 81: 19-25.
[30]	Pall M, Azziz R, Beires J, Pignatelli D. The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia. FertilSteril. 2010; 94: 684-9.
[31]	DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 2017; 14: 173–194.
[32]	Goodyear LJ, Kahn BB. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med 2019; 49: 235–261.
[33]	Eriksson J, Franssila-Kallunki A, Ekstrand A, Saloranta C, Widen E, Schalin C, Groop L. Early metabolic defects in persons at increased risk for non-insulin-dependent diabetes mellitus. N Engl J Med 2019; 321: 337–343.
[34]	Coskun A, Ercan O, Arikan DC, Ozer A, Kilinc M, Kiran G, Kostu B. Modified Ferriman-Gallwey hirsutism score and androgen levels in Turkish women. Eur J Obstet Gynecol ReprodBiol 2011; 154: 167–171.
[35]	Ref.Wilson JMG, Jungner G; Organization WH. Principles and practice of screening for disease. World Health Organization, 2020.
[36]	Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J ClinEndocrinolMetab 2013; 98: 4565-4592.
[37]	Jean Hailes for women’s health on behalf of the PCOS Australian alliance. Evidence-based guidelines for the assessment and management of polycystic ovary syndrome. Melbourne: Jean Hailes Foundation for Women’s Health on behalf of the PCOS Australian Alliance, 2015: 64–65.
[38]	Royal College of Obstetricians and Gynaecologists. Polycystic Ovary Syndrome, Long-term Consequences (Green-top Guideline No. 33).
[39]	VellingMagnussen L, Mumm H, Andersen M, Glintborg D. Hemoglobin A1c as a tool for the diagnosis of type 2 diabetes in 208 premenopausal women with polycystic ovary syndrome. FertilSteril 2019; 96: 1275-1280.
[40]	Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012; 33: 981-1030.
[41]	Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J ClinEndocrinolMetab. 2008; 93: 162-8.
[42]	Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Assessment of glucose metabolism in polycystic ovary syndrome: HbA1c or fasting glucose compared with the oral glucose tolerance test as a screening method. Human reproduction (Oxford, England). 2013; 28: 2537-44.
[43]	HolteJ, BerghT, BerneC, BerglundL, LithellH.Enhancedearly insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance. J ClinEndocrinolMetab 2014; 78: 1052–1058.
[44]	Altemimi MT, et al. Screening Tool for Dysglycemia in Polycystic Ovary Syndrome. Indones Biomed J. 2021; 13(2): 178-85.