Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome
Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome
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DOI：
10.2337/diacare.22.1.141
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发表时间：
1999-01-01
期刊：
影响因子：
16.2
通讯作者：
Imperial, J
中科院分区：
文献类型：
--
作者：
Ehrmann, DA;Barnes, RB;Imperial, J
目的：非胰岛素依赖型糖尿病(NIDDM)多见于多囊卵巢综合征(PCOS)患者。其前体糖耐量受损(IGT)的患病率和自然病史鲜为人知。研究设计与方法：从芝加哥大学医学、内分泌学、妇科和儿科诊所招募了122名有多囊卵巢综合征临床和激素证据的女性。所有女性都接受了标准的口服葡萄糖耐量试验(OGTT)，测量了血糖和胰岛素水平。结果：122名女性中有55名(45%)糖耐量异常：43名(35%)在最初研究时有IGT，12名(10%)有NIDDM。患有NIDDM的女性与糖耐量正常的女性的不同之处在于，她们的一级亲属NIDDM的患病率是前者的2.6倍(83比31%，P<；0.01)，而且明显更肥胖(BMI 41.0+/-2.4比33.4+/-1.1 kg/m(2)，P<；0.01)。在整个队列中，空腹血糖浓度与2-h血糖浓度显著相关(r=0.76，P=0.0001)；在糖耐量减低患者中，空腹血糖浓度对2-h血糖水平的预测很差(r=0.25，NS)。经过平均2.4+/-0.3年(0.5-6.3)的随访，25名女性发生了第二次OGTT。第二次糖耐量试验中2小时的血糖浓度显著高于第一次研究中的2小时浓度(161+/-9)和139+/-6 mg/dl(P<；0.02)。结论：与年龄和体重匹配的非PCOS妇女相比，PCOS妇女IGT和NIDDM的患病率显著高于预期。在PCOS中加速了从IGT到NIDDM的转换。空腹血糖浓度不能可靠地预测口服葡萄糖刺激后2小时的血糖浓度，特别是在IGT患者中，IGT是NIDDM后续发展的最高风险亚组。我们的结论是，患有多囊卵巢综合征的女性应该定期进行OGTT，并必须密切监测糖耐量的恶化。
OBJECTIVE - NIDDM occurs commonly among women with polycystic ovary syndrome (PCOS). The prevalence and natural history of its precursor, impaired glucose tolerance (IGT), is less well known. The objective of this study was to characterize the prevalence and incidence of glucose intolerance in a large cohort of women with well-characterized PCOS.RESEARCH DESIGN AND METHODS - A total of 122 women with clinical and hormonal evidence of PCOS were recruited from the Medicine, Endocrinology, Gynecology and Pediatrics Clinics at the University of Chicago. All women had a standard oral glucose tolerance test (OGTT) with measurement of glucose and insulin levels. A subset of 25 women were subsequently restudied with the aim of characterizing the natural history of glucose tolerance in PCOS.RESULTS - Glucose tolerance was abnormal in 55 (45%) of the 122 women: 43 (35%) had IGT and 12 (10%) had NIDDM at the time of initial study. The women with NIDDM differed from those with normal glucose tolerance in that they had a 2.6-fold higher prevalence of first-degree relatives with NIDDM (83 vs. 31%, P < 0.01 by chi(2)) and were significantly more obese (BMI 41.0 +/- 2.4 vs. 33.4 +/- 1.1 kg/m(2), P < 0.01). For the entire cohort of 122 women, there was a significant correlation between fasting and 2-h glucose concentrations (r = 0.76, P = 0.0001); among the subset with IGT, the fasting glucose concentration was poorly predictive of the 2-h level (r = 0.25, NS). After a mean follow-up of 2.4 +/- 0.3 years (range 0.5-6.3), 25 women had a second OGTT. The glucose concentration at 2 h during the second glucose tolerance test was significantly higher than the 2-h concentration during the first study (161 +/- 9) vs. 139 +/- 6 mg/dl, P < 0.02).CONCLUSIONS - The prevalence of IGT and NIDDM in women with PCOS is substantially higher than expected when compared with age- and weight-matched populations of women without PCOS. The conversion from IGT to NIDDM is accelerated in PCOS. The fasting glucose concentration does not reliably predict the glucose concentration at 2 h after an oral glucose challenge, particularly among those with IGT, the subgroup at highest risk for subsequent development of NIDDM. We conclude that women with PCOS should periodically have an OGTT and must be closely monitored for deterioration in glucose tolerance.