Comparisons Of Glucose Intolerance Testing For The Detection And Diagnosis Of Prediabetes And Type Ii Diabetes Mellitus In Reproductive Age Women With Polycystic Ovary Syndrome.

Polycystic Ovary Syndrome (PCOS) is one of the most common metabolic conditions affecting reproductive-age women. Its etiology is not completely understood. PCOS is diagnosed using the 2003 Rotterdam Criteria (ROT), in which patients must meet at least two of the three following criteria: (1) clinical or biochemical evidence of hyperandrogenism, (2) anovulation/oligomenorrhea and (3) polycystic ovarian morphology on ultrasound with the exclusion of other etiologies (e.g., congenital adrenal hyperplasia, androgen-secreting tumors, Cushing's syndrome). Although not included in the Rotterdam criteria, one of the metabolic features of PCOS is glucose intolerance and insulin resistance. PCOS patients have a four to eight-fold increased risk of developing Type II Diabetes Mellitus (DM) making the proper diagnosis imperative in this patient population. Therefore, we sought to determine the most sensitive way to screen for abnormal glucose metabolism in this patient population. A retrospective chart review (IRB# 19-477) was performed for all women (18-45 years of age) who presented to the Reproductive Endocrinology and Fertility clinic at Southern Illinois University School of Medicine who received glucose testing (2 hour oral glucose tolerance test (OGTT) with a 75gm glucose load, Hemoglobin A1c (Hgb A1c) and insulin levels (fasting and 2-hour post-prandial) at their initial visit as part of their evaluation for PCOS between 07/01/2012 and 07/01/2019. Of the 646 charts that were reviewed, 345 women met the eligibility criteria, of which 118 were confirmed to have PCOS based on the 2003 Rotterdam Criteria; however, we removed 17 subjects who were utilizing Metformin/Glucophage at the time of evaluation. Additional criteria such as age, body mass index (BMI), gravity and parity, etc. were also collected. Glucose intolerance was defined by the American Diabetes Association guidelines (fasting glucose: 100-125 mg/dL, normal < 100 mg/dL; 2hr OGTT 140 to 199 mg/dL, normal < 140 mg/dL; Hgb A1C 5.7% to 6.4%, normal < 5.7%. Of the 101 PCOS subjects, the 2 hour OGTT detected glucose intolerance in 7.5% of the population. Fasting glucose found 14.5% of the subjects to have glucose intolerance and Hgb A1C identified 9.5% of the PCOS patients to have glucose intolerance. Based on these preliminary results, fasting glucose tests may be the more sensitive test for women with PCOS. However, these variations in sensitivity prove further investigations are warranted. Furthermore, we aim to determine which characteristics/phenotypes may exacerbate this discordance between diagnostic tests.