Assessment of glucose metabolism in polycystic ovary syndrome: HbA1c or fasting glucose compared with the oral glucose tolerance test as a screening method

作者：Lerchbaum E^*; Schwetz V; Giuliani A; Obermayer Pietsch B

来源：Human Reproduction, 2013, 28(9): 2537-2544.

DOI：10.1093/humrep/det255

• polycystic ovary syndrome
• oral glucose tolerance test
• prediabetes
• type 2 diabetes
• HbA1c

Are HbA1c and fasting glucose (FG) useful in predicting the presence of prediabetes and type 2 diabetes (T2DM) in a large cohort of women with polycystic ovary syndrome (PCOS)? %26lt;br%26gt;HbA1c and FG are not suitable as screening tools for prediabetes in a large cohort of PCOS women but do show a good level of agreement with T2DM. %26lt;br%26gt;Women with PCOS have an increased risk of prediabetes and T2DM. As performing an oral glucose tolerance test (OGTT) is time consuming, HbA1c and FG have been suggested as screening tools for prediabetes and T2DM. %26lt;br%26gt;This was a cross-sectional study of 671 women with PCOS conducted from 2006 to 2012. %26lt;br%26gt;The study was carried out at the endocrinological outpatient department of the Medical University of Graz, Austria. We performed 75 g 2-h OGTTs and measured HbA1c in 671 women with PCOS aged 1645 years with a median BMI of 24.2 (21.330.1) kg/m(2). PCOS was defined according to the Rotterdam criteria. Prediabetes (FG 100125 mg/dl and/or 2-h glucose 140199 mg/dl and/or HbA1c 5.76.4) and T2DM (FG 126 mg/dl and/or 2-h glucose 200 mg/dl and/or HbA1c 6.5) were diagnosed according to the American Diabetes Association (ADA) criteria. Levels of agreement between different definitions were analyzed using -index. %26lt;br%26gt;According to the ADA criteria, we found prediabetes and T2DM in 12.8 (n 76) and 1.5 (n 9) of PCOS women, respectively. When using elevated HbA1c (5.76.4) for defining prediabetes, 19 (3.2) of all PCOS women had prediabetes with a -index of 0.36. When using elevated FG (100125 mg/dl) for defining prediabetes, 31 (5.2) of all the PCOS women were diagnosed with prediabetes with a -index of 0.05. Further, elevated HbA1c (6.5 defining T2DM) was found in six (0.9) PCOS women (-index 0.80), and elevated FG (126 mg/dl diagnosing T2DM) was found in seven PCOS women (1; -index 0.82). %26lt;br%26gt;Our results are limited to an Austrian cohort of PCOS women diagnosed by Rotterdam criteria with a median BMI in the normal weight range. %26lt;br%26gt;Our results are in line with results from previous smaller PCOS cohorts. Our findings do not support the recommendation that FG or HbA1c can be used for the screening of prediabetes in women with PCOS. For such women, OGTT should be performed for screening of prediabetes. Whether this finding is generalizable to other cohorts remains to be determined in further studies.

• 出版日期2013-9