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Targeted PCOS screening more cost effective than universal screening
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MONTREAL — Despite guidelines recently released from The Endocrine Society recommending universal screening for glucose abnormalities in adolescents with polycystic ovary syndrome, data from retrospective research presented here at the annual meeting of the Canadian Pediatric Endocrine Group suggest more selective screening of dysglycemia may be warranted.
“Current recommendations from these clinical practice guidelines are based on very small reports in adolescents or extrapolated from adult literature, and state that adolescents with PCOS should be universally screened,” said Nicole Coles, MD, a third-year resident in pediatrics at the Hospital for Sick Children in Toronto.
“In the largest study to date, it was found that overweight and obese teens with PCOS had glucose abnormalities, but we did not find that normal weight patients had any glucose intolerance,” Coles said in an interview with Endocrine Today.
Based on their findings of 300 patients who had a mean age of 15 years, a mean BMI of 30.4 and who met the criteria for PCOS, Coles put forth that targeted screening of higher risk adolescents with PCOS might be more cost-effective than universal screening.
They also found the oral glucose tolerance test was superior to detecting glucose abnormalities than the fasting plasma glucose test. Overall, 219 patients were screened, with 163 undergoing an OGTT and the balance undergoing the FPG test. All 28 patients with dysglycemia were detected using the OGTT, but the FPG identified only two of 28 patients with dysglycemia.
“OGTT is an optimal test for detection, but it is more time-intensive and inconvenient for patients,” Coles said.
Investigators also found through multivariate analysis that patients with dysglycemia also had other features of the metabolic syndrome such as reduced HDL and elevated triglyceride levels.
One of the limitations of the study was that it was a retrospective design, and information such as ethnicity was not captured, Coles said.
“We know that different ethnicities have different risk factors,” she said.
Another limitation was the absence of a control group. A future investigation would ideally take a prospective design and follow patients longitudinally, according to Coles. – by Louise Gagnon
For more information:
Coles N. Oral abstract #2. Presented at: Canadian Pediatric Endocrine Group 2014 Scientific Meeting; Feb. 20-22, 2014; Montreal.
Disclosure: Coles reports no relevant financial disclosures.