Response to Letter to the Editor: “Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome”

Response to Letter to the Editor: “Development and Risk Factors of Type 2 Diabetes in a... Thank you very much for the opportunity to add results for normal-weight women in our study population. We agree that these data are important for the current discussion of the risk of type 2 diabetes (T2D) in normal-weight women with polycystic ovary syndrome (PCOS) (1, 2). In addition, we present data for waist circumference ≥88 cm as an indicator for central obesity, confirming it as an important predictor of insulin resistance in our PCOS cohort (3). Additional Results for PCOS Odense University Hospital Baseline body mass index (BMI) <25 kg/m2 and later development of T2D was observed in 12 of 1082 (1%) women in PCOS Odense University Hospital (OUH), whereas 99 of 1082 (9%) with baseline BMI ≥25 kg/m2 developed T2D (Table 1). The odds ratio was 6.61 (95% confidence interval, 3.22 to 13.58; P < 0.001) for development of T2D in women with PCOS and BMI ≥25 kg/m2 vs women with PCOS and BMI <25 kg/m2. Table 1. Baseline Clinical Characteristics According to Development of T2D (GDM Included) in PCOS OUH   Development of T2D (GDM Included)      Yes  No    N = 115  N = 1047  Baseline Characteristics  N (%)  Median (Q1 to Q3)  N (%)  Median (Q1 – Q3)  Pa  Age, y  115 (100)  31 (26 to 36)  1,047 (100)  28 (22 to 34)  0.045  BMI, kg/m2  111 (97)  32.3 (27.9 to 36.5)  971 (92)  26.3 (22.6 to 31.2)  <0.001  Waist, cm  65 (56)  102 (91 to 112)  664 (63)  87 (77 to 101)  <0.001  BMI <25 kg/m2  12 (11)    418 (43)    <0.001  BMI ≥25 kg/m2  99 (89)    553 (57)      Waist <88 cm  9 (14)    342 (51)    <0.001  Waist ≥88 cm  56 (86)    322 (49)        Development of T2D (GDM Included)      Yes  No    N = 115  N = 1047  Baseline Characteristics  N (%)  Median (Q1 to Q3)  N (%)  Median (Q1 – Q3)  Pa  Age, y  115 (100)  31 (26 to 36)  1,047 (100)  28 (22 to 34)  0.045  BMI, kg/m2  111 (97)  32.3 (27.9 to 36.5)  971 (92)  26.3 (22.6 to 31.2)  <0.001  Waist, cm  65 (56)  102 (91 to 112)  664 (63)  87 (77 to 101)  <0.001  BMI <25 kg/m2  12 (11)    418 (43)    <0.001  BMI ≥25 kg/m2  99 (89)    553 (57)      Waist <88 cm  9 (14)    342 (51)    <0.001  Waist ≥88 cm  56 (86)    322 (49)      Abbreviation: GDM, gestational diabetes mellitus. a Nonparametric test on the equality of medians or χ2 test. View Large Baseline waist circumference <88 cm and later development of T2D was observed in 9 of 729 (1%) women in PCOS OUH, whereas 56 of 729 (8%) with baseline waist circumference ≥88 cm developed T2D. The odds ratio was 6.24 (95% confidence interval, 3.38 to 11.50; P < 0.001) for development of T2D in women with PCOS and waist circumference ≥88 cm vs women with PCOS and waist circumference <88 cm. PCOS OUH vs Controls The hazard ratio was 1.22 (95% confidence interval, 0.58 to 2.55; P = 0.60) for development of T2D in lean (BMI <25 kg/m2) women with PCOS vs age-matched controls. The hazard ratio was 6.57 (95% confidence interval, 4.53 to 9.54; P < 0.001) for development of T2D in women with PCOS and BMI ≥25 kg/m2 vs age-matched controls. Discussion Our data support a low risk for development of T2D in normal-weight women with PCOS, and the risk for developing T2D in lean women with PCOS was comparable to that of age-matched controls. Our data are supported by the articles mentioned in the letter by Livadas. We wonder whether the table provided by Livadas should also include the study by Ollila et al. (1) regarding results from oral glucose tolerance tests in a Finnish study population. Furthermore, we have an article in press regarding the outcome of oral glucose tolerance tests in a Nordic study population of women with PCOS (4). We performed oral glucose tolerance tests in 876 Nordic women with PCOS, aged 14 to 57 years, and found that no woman with BMI <25 kg/m2 had a diagnosis of T2D (4). Taken together, the available results indicate that lean women with PCOS may not need prospective screening for T2D during follow-up. Acknowledgments Disclosure Summary: The authors have nothing to disclose. Abbreviations: BMI body mass index PCOS polycystic ovary syndrome T2D type 2 diabetes. References 1. Ollila ME, West S, Keinänen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen LC. Overweight and obese but not normal weight women with PCOS are at increased risk of type 2 diabetes mellitus: a prospective, population-based cohort study. Hum Reprod . 2017; 32( 2): 423– 431. Google Scholar CrossRef Search ADS PubMed  2. Glintborg D, Andersen M. Medical comorbidity in polycystic ovary syndrome with special focus on cardiometabolic, autoimmune, hepatic and cancer diseases: an updated review. Curr Opin Obstet Gynecol . 2017; 29( 6): 390– 396. Google Scholar PubMed  3. Glintborg D, Petersen MH, Ravn P, Hermann AP, Andersen M. Comparison of regional fat mass measurement by whole body DXA scans and anthropometric measures to predict insulin resistance in women with polycystic ovary syndrome and controls. Acta Obstet Gynecol Scand . 2016; 95( 11): 1235– 1243. Google Scholar CrossRef Search ADS PubMed  4. Pelanis R, Mellembakken JR, Sundström-Poromaa I, Ravn P, Morin-Papunen L, Tapanainen JS, Piltonen T, Puurunen J, Hirschberg AL, Fedorcsak P, Andersen M, Glintborg D. The prevalence of type 2 diabetes is not increased in normal-weight women with PCOS. Hum Reprod . 2017; 32( 11): 2279– 2286. Google Scholar CrossRef Search ADS PubMed  Copyright © 2018 Endocrine Society http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Endocrinology and Metabolism Oxford University Press

Response to Letter to the Editor: “Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome”

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Publisher
Endocrine Society
Copyright
Copyright © 2018 Endocrine Society
ISSN
0021-972X
eISSN
1945-7197
D.O.I.
10.1210/jc.2017-02123
Publisher site
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Abstract

Thank you very much for the opportunity to add results for normal-weight women in our study population. We agree that these data are important for the current discussion of the risk of type 2 diabetes (T2D) in normal-weight women with polycystic ovary syndrome (PCOS) (1, 2). In addition, we present data for waist circumference ≥88 cm as an indicator for central obesity, confirming it as an important predictor of insulin resistance in our PCOS cohort (3). Additional Results for PCOS Odense University Hospital Baseline body mass index (BMI) <25 kg/m2 and later development of T2D was observed in 12 of 1082 (1%) women in PCOS Odense University Hospital (OUH), whereas 99 of 1082 (9%) with baseline BMI ≥25 kg/m2 developed T2D (Table 1). The odds ratio was 6.61 (95% confidence interval, 3.22 to 13.58; P < 0.001) for development of T2D in women with PCOS and BMI ≥25 kg/m2 vs women with PCOS and BMI <25 kg/m2. Table 1. Baseline Clinical Characteristics According to Development of T2D (GDM Included) in PCOS OUH   Development of T2D (GDM Included)      Yes  No    N = 115  N = 1047  Baseline Characteristics  N (%)  Median (Q1 to Q3)  N (%)  Median (Q1 – Q3)  Pa  Age, y  115 (100)  31 (26 to 36)  1,047 (100)  28 (22 to 34)  0.045  BMI, kg/m2  111 (97)  32.3 (27.9 to 36.5)  971 (92)  26.3 (22.6 to 31.2)  <0.001  Waist, cm  65 (56)  102 (91 to 112)  664 (63)  87 (77 to 101)  <0.001  BMI <25 kg/m2  12 (11)    418 (43)    <0.001  BMI ≥25 kg/m2  99 (89)    553 (57)      Waist <88 cm  9 (14)    342 (51)    <0.001  Waist ≥88 cm  56 (86)    322 (49)        Development of T2D (GDM Included)      Yes  No    N = 115  N = 1047  Baseline Characteristics  N (%)  Median (Q1 to Q3)  N (%)  Median (Q1 – Q3)  Pa  Age, y  115 (100)  31 (26 to 36)  1,047 (100)  28 (22 to 34)  0.045  BMI, kg/m2  111 (97)  32.3 (27.9 to 36.5)  971 (92)  26.3 (22.6 to 31.2)  <0.001  Waist, cm  65 (56)  102 (91 to 112)  664 (63)  87 (77 to 101)  <0.001  BMI <25 kg/m2  12 (11)    418 (43)    <0.001  BMI ≥25 kg/m2  99 (89)    553 (57)      Waist <88 cm  9 (14)    342 (51)    <0.001  Waist ≥88 cm  56 (86)    322 (49)      Abbreviation: GDM, gestational diabetes mellitus. a Nonparametric test on the equality of medians or χ2 test. View Large Baseline waist circumference <88 cm and later development of T2D was observed in 9 of 729 (1%) women in PCOS OUH, whereas 56 of 729 (8%) with baseline waist circumference ≥88 cm developed T2D. The odds ratio was 6.24 (95% confidence interval, 3.38 to 11.50; P < 0.001) for development of T2D in women with PCOS and waist circumference ≥88 cm vs women with PCOS and waist circumference <88 cm. PCOS OUH vs Controls The hazard ratio was 1.22 (95% confidence interval, 0.58 to 2.55; P = 0.60) for development of T2D in lean (BMI <25 kg/m2) women with PCOS vs age-matched controls. The hazard ratio was 6.57 (95% confidence interval, 4.53 to 9.54; P < 0.001) for development of T2D in women with PCOS and BMI ≥25 kg/m2 vs age-matched controls. Discussion Our data support a low risk for development of T2D in normal-weight women with PCOS, and the risk for developing T2D in lean women with PCOS was comparable to that of age-matched controls. Our data are supported by the articles mentioned in the letter by Livadas. We wonder whether the table provided by Livadas should also include the study by Ollila et al. (1) regarding results from oral glucose tolerance tests in a Finnish study population. Furthermore, we have an article in press regarding the outcome of oral glucose tolerance tests in a Nordic study population of women with PCOS (4). We performed oral glucose tolerance tests in 876 Nordic women with PCOS, aged 14 to 57 years, and found that no woman with BMI <25 kg/m2 had a diagnosis of T2D (4). Taken together, the available results indicate that lean women with PCOS may not need prospective screening for T2D during follow-up. Acknowledgments Disclosure Summary: The authors have nothing to disclose. Abbreviations: BMI body mass index PCOS polycystic ovary syndrome T2D type 2 diabetes. References 1. Ollila ME, West S, Keinänen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen LC. Overweight and obese but not normal weight women with PCOS are at increased risk of type 2 diabetes mellitus: a prospective, population-based cohort study. Hum Reprod . 2017; 32( 2): 423– 431. Google Scholar CrossRef Search ADS PubMed  2. Glintborg D, Andersen M. Medical comorbidity in polycystic ovary syndrome with special focus on cardiometabolic, autoimmune, hepatic and cancer diseases: an updated review. Curr Opin Obstet Gynecol . 2017; 29( 6): 390– 396. Google Scholar PubMed  3. Glintborg D, Petersen MH, Ravn P, Hermann AP, Andersen M. Comparison of regional fat mass measurement by whole body DXA scans and anthropometric measures to predict insulin resistance in women with polycystic ovary syndrome and controls. Acta Obstet Gynecol Scand . 2016; 95( 11): 1235– 1243. Google Scholar CrossRef Search ADS PubMed  4. Pelanis R, Mellembakken JR, Sundström-Poromaa I, Ravn P, Morin-Papunen L, Tapanainen JS, Piltonen T, Puurunen J, Hirschberg AL, Fedorcsak P, Andersen M, Glintborg D. The prevalence of type 2 diabetes is not increased in normal-weight women with PCOS. Hum Reprod . 2017; 32( 11): 2279– 2286. Google Scholar CrossRef Search ADS PubMed  Copyright © 2018 Endocrine Society

Journal

Journal of Clinical Endocrinology and MetabolismOxford University Press

Published: Jan 1, 2018

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