20% of girls with type 2 diabetes have PCOS, meta-analysis finds
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Approximately one in five girls with type 2 diabetes have polycystic ovary syndrome, according to findings of a meta-analysis in JAMA Network Open.
“PCOS is a complex endocrine disorder that occurs in 1.14% to 11.04% of adolescent girls globally,” Milena Cioana, BHSc, of the department of pediatrics at McMaster University and the division of pediatric endocrinology at McMaster Children’s Hospital in Ontario, Canada, and colleagues wrote.
“However, although PCOS is associated with a range of conditions that are related to obesity, the association of PCOS with obesity is not well understood,” they added. “PCOS is more common in adolescents with obesity, yet insulin resistance is at times present in patients with PCOS regardless of their BMI.”
Cioana and colleagues reviewed databases for literature up until April 4, 2021. They included studies for analysis if they:
- reported PCOS in girls who were diagnosed with type 2 diabetes at 18 years of age or younger;
- were cross-sectional, retrospective or prospective by design;
- had a sample size of at least 10 patients; and
- reported the prevalence of PCOS in patients with diabetes.
The researchers assessed the appropriateness and quality of the data using the Oxford Centre for Evidence-Based Medicine criteria.
The final analysis included six cohort studies — five retrospective and one prospective — involving 470 girls with diabetes (mean age at diabetes diagnosis, 12.9 to 16.1 years). Among all participants, 19.58% (95% CI, 12.02%-27.14%) had PCOS, which was defined as “persistent oligomenorrhea and clinical and/or biochemical hyperandrogenism” in three studies and was unclear in the others.
In the two studies reporting PCOS prevalence by race, 36 (17%) white girls, 195 (23.1%) Indian girls and 64 (2%) Indigenous girls in Canada had PCOS.
“On the basis of studies with mostly moderate risk of bias, this systematic review and meta-analysis demonstrated that approximately one in five girls with [diabetes] have PCOS,” they wrote. “This figure is substantially higher than PCOS prevalence among the general female adolescent population.”
However, the meta-analysis was limited because some of the studies failed to establish diagnostic criteria for PCOS and did not report the time of menarche. Also, none of the studies used PCOS as a primary outcome.
“Given these limitations, the results should be interpreted with caution,” Cioana and colleagues wrote. “Larger multiethnic, longitudinal cohort studies evaluating PCOS prevalence in girls with [diabetes] and using standardized criteria for defining PCOS are urgently needed.”
Perspective
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PCOS is one of the most common endocrine disorders affecting adolescent females. This study found that in female adolescents with type 2 diabetes mellitus, the prevalence of PCOS was substantially higher than among the general female adolescent population, with approximately 1 in 5 females identified with PCOS diagnosis. The authors concluded that it is important to screen for PCOS at the time of type 2 diabetes diagnosis.
PCOS in adolescence has been associated with several medical conditions such as metabolic syndrome, hypertension, hyperglycemia, insulin resistance and dyslipidemia with increased cardiovascular risk. Early diagnosis of PCOS in this at-risk patient population with diabetes would allow for early screening and management of associated health concerns to prevent the development of complications. In addition, this study highlights the need for a consensus to establish the pediatric diagnostic criteria for PCOS to ensure accurate diagnosis. As physicians, we serve as advocates for the future health of our patients. If we can intervene early on and prevent future health complications, we are helping to give our patients a healthy future.
Some of the major study limitations were that the authors were unable to determine the role of obesity in the relationship between diabetes and PCOS or address the association of race with PCOS prevalence due to lack of studies reporting obesity status or race-specific data. This information is particularly important in the pediatric type 2 diabetes population. Of note, the studies including larger numbers of adolescents did not report the criteria used to diagnose PCOS. The results of this study highlight the difficulty in diagnosing PCOS in adolescent females due to varying criteria from current guidelines available and the need for a consensus in establishing diagnostic criteria for PCOS in adolescents.
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