The Link Between Polycystic Ovary Syndrome (PCOS) and Diabetes: Prevalence and Management

1. Introduction

   1. Definition of PCOS and Diabetes:

      Polycystic ovary syndrome (PCOS) is a condition characterized by a collection of signs and symptoms indicating excess androgen production and dysfunction of the ovaries. These symptoms occur in the absence of any other identifiable conditions that could explain them. The signs and symptoms of PCOS may include irregular menstrual cycles, hirsutism (excessive hair growth in a male pattern), and acne. Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder that impacts a significant number of women during their reproductive years. (Escobar-Morreale, 2018).

      Diabetes, often known as diabetes mellitus, is a cluster of metabolic conditions that are distinguished by extended periods of high blood glucose levels. The high blood sugar levels result from either insufficient insulin production by the pancreas, or the body’s cells becoming resistant to insulin, or a combination of both.

   2. Prevalence of PCOS and Diabetes:

      According to a study, the overall prevalence of PCOS among women with Type 2 Diabetes Mellitus was around 21%. The incidence of PCOS was found to be higher among female patients aged 25-45 years as compared to those below 25 years of age. Furthermore, the prevalence of PCOS was lower among obese women at 14% as compared to women of normal weight or those who were overweight or obese. Oceania had the highest incidence of PCOS in women with T2DM, followed by Europe and Asia. On the other hand, North America had the lowest incidence. The prevalence of PCOS was found to be the lowest when diagnosed according to the National Institutes of Health diagnostic standards, while the prevalence was the highest when diagnosed on the basis of clinical symptoms and biochemical characteristics. Finally, the prevalence of PCOS diagnosed through medical records was found to be 20%.

      (Caiyi Long, Haoyue Feng, & Wen Duan, 2022).

   3. Relationship Between PCOS and Diabetes:

      Polycystic ovary syndrome (PCOS) is commonly found in women who also have dysglycemic conditions, such as impaired glucose tolerance and type 2 diabetes mellitus (T2D). The link between these conditions is mainly due to shared pathogenetic pathways, specifically insulin resistance. However, the relationship between type 2 diabetes mellitus (T2D) and PCOS is not completely understood due to methodological issues and the complex nature of the syndrome. The purpose of this review is to provide the most reliable evidence regarding the epidemiology of dysglycemia in PCOS, the unique mechanisms underlying the progression of dysglycemia, the most effective ways to evaluate glycemic status, and the risk factors for developing type 2 diabetes mellitus (T2D) in this population, as well as the risk of developing type 2 diabetes mellitus after menopause. The review suggests a holistic approach to managing T2D risk in women with PCOS, including adopting a healthy lifestyle, avoiding foods and drinks that disrupt endocrine function, regular exercise, and considering certain medications such as metformin and glucagon-like peptide 1 receptor agonists. Maintaining a healthy weight is highlighted as a key factor in reducing type 2 diabetes mellitus risk in women with PCOS.

      (Sarantis Livadas, Panagiotis Anagnostis, Julia K Bosdou, Dimitra Bantouna, & Rodis Paparodis, 2022).

   4. Purpose of the Article:

      The purpose of this article is to explore the relationship between polycystic ovary syndrome (PCOS) and diabetes, including the prevalence of diabetes in women with PCOS and the potential mechanisms underlying the association. The article may also discuss strategies for the prevention and management of diabetes in women with PCOS. The goal is to provide a comprehensive understanding of the link between PCOS and diabetes and to inform healthcare providers and patients about the implications of this connection for diagnosis and treatment.

2. Overview of PCOS

   1. Symptoms of PCOS:

      The symptoms of PCOS in women may include hirsutism (excessive hair growth in a male pattern), amenorrhea (absence of menstrual periods), dysmenorrhea (painful menstrual periods), and Oligomenorrhoea (infrequent or irregular menstrual periods). These clinical manifestations may arise from excess androgen levels and ovarian dysfunction, and may impact a woman’s reproductive and metabolic health. Women with PCOS may require ongoing medical management to address their symptoms and minimize their risk of long-term health complications

      (Somia Gul, Syeda Adeeba Zahid, & Almas Ansari, 2014).

   2. Causes of PCOS:

      The etiology of PCOS is complex and multifactorial, with both genetic and environmental factors contributing to the development and severity of the condition. For instance, poor lifestyle choices such as an unhealthy diet and a sedentary lifestyle can exacerbate the impact of PCOS, especially in those who are susceptible. While some studies have suggested that other environmental factors like infectious agents and toxins might play a role in PCOS, more research is needed to support these claims. Genetic studies of PCOS have been challenging due to phenotype confusion, and the evidence supporting proposed PCOS genes such as CYP11A, the insulin gene, the follistatin gene, and a region near the insulin receptor, is not conclusive (Evanthia Diamanti-Kandarakis, Helen Kandarakis, & Richard S Legro, 2006).

   3. Diagnosis of PCOS:

      To diagnose polycystic ovary syndrome (PCOS), clinicians primarily rely on medical history and physical examination. The key features of the condition are hirsutism or elevated androgen levels, and irregular menstrual cycles due to chronic anovulation. Other common symptoms include insulin resistance with compensatory hyperinsulinemia and obesity. The diagnosis of PCOS has been facilitated by the use of ultrasound imaging of the ovaries. It is crucial to exclude alternative medical conditions that can imitate the symptoms of PCOS, such as hyperthecosis, congenital adrenal hyperplasia, or 21-hydroxylase deficiency (Chang, 2004).

   4. Treatment Options for PCOS:

      PCOS management is customized based on individual symptoms, which can involve ovulatory dysfunction, menstrual disorders, or androgen excess. Losing weight is a recommended approach that can improve the endocrine profile, increase ovulation and the odds of pregnancy. Even modest weight loss, as little as 5% of starting body weight, can induce ovulation and normalize menstrual cycles. Obesity treatment in PCOS can involve lifestyle adjustments like dietary changes and exercise, or medical and surgical interventions. Anovulation in PCOS arises from low follicle-stimulating hormone levels and the arrest of antral follicle growth during maturation. Medications including clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins, and laparoscopic ovarian drilling are the possible treatments. In vitro fertilization is the final option for achieving pregnancy if other treatments fail

      (Ahmed Badawy & Abubakar Elnashar, 2011).

3. Overview of Diabetes

   1. Types of Diabetes:

      Diabetes Mellitus is a long-standing metabolic disorder that is identified by increased levels of blood glucose caused by inadequate insulin secretion, impaired insulin action, or both. This disorder is categorized into three primary types:

      • Types 1 Diabetes: Type 1 diabetes is a medical condition that typically arises in childhood or adolescence, resulting from the destruction of the insulin-producing cells in the pancreas due to an autoimmune response. This destruction leads to a complete deficiency of insulin and necessitates lifelong replacement therapy with insulin.
      • Type 2 Diabetes: Type 2 diabetes is a prevalent form of diabetes that is identified by the body’s insulin resistance and a relative lack of insulin. This type of diabetes is often linked with factors like obesity, lack of physical activity, and unhealthy dietary patterns.
      • Gestational Diabetes: This type of diabetes develops during pregnancy and typically resolves after delivery. It is caused by insulin resistance and impaired insulin secretion, and it increases the risk of adverse outcomes for both the mother and the fetus. Women with gestational diabetes require careful monitoring and often need lifestyle modifications or insulin therapy to maintain optimal blood glucose levels (Akram T Kharroubi & Hisham M Darwish, 2015).

   2. Symptoms of Diabetes:

      Symptoms such as polyuria, polydipsia, and polyphagia are typical of diabetes, occurring frequently in type 1 diabetes, which develops quickly with severe hyperglycemia, and in type 2 diabetes with extremely high levels of hyperglycemia. Rapid weight loss usually occurs in type 1 diabetes or in cases of undiagnosed type 2 diabetes that persist for an extended period. Additionally, fatigue, restlessness, unexplained weight loss, and body aches are common signs of undiagnosed diabetes. Mild or slowly developing symptoms could go unnoticed (Ramachandran, 2014).

   3. Causes of Diabetes:

      Both genetic and environmental factors contribute to the development of diabetes mellitus. Environmental factors that increase the risk of diabetes include physical inactivity, obesity, viral infections, drugs and toxic agents, and location. Although type 1 diabetes is not entirely predetermined by genetics, there is a genetic predisposition that can increase susceptibility. In contrast, type 2 diabetes has a stronger genetic component, with high concordance rates observed in monozygotic twins. However, environmental factors can modify the expression of diabetes susceptibility genes, making it more likely for the disease to occur. Therefore, an individual with a genetic susceptibility to diabetes may only develop the disease when the expression of these genes is altered by environmental factors

      (Ernest Adeghate, Peter Schattner, & Earl Dunn, 2006).

   4. Diagnosis and Treatment of Diabetes:

      The diagnostic criteria for diabetes mellitus are based on measuring the venous plasma glucose levels. A diagnosis of diabetes can be made if an occasional plasma glucose level is equal to or greater than 200 mg/dL (or 11.1 mmol/L), a fasting plasma glucose level is equal to or greater than 126 mg/dL (or 7.0 mmol/L) after fasting for 8-12 hours, or if the 2-hour value of oral glucose tolerance test (OGTT) in venous plasma is equal to or greater than 200 mg/dL (or 11.1 mmol/L). Specific procedures need to be followed for conducting the OGTT

      (Astrid Petersmann, Dirk Muller-Wieland, Ulrich A. Muller, & Rudiger Landgraf, 2019).

      The management of Type 2 diabetes mellitus requires a holistic approach that involves educating patients, modifying their lifestyle, achieving optimal glycemic control, reducing cardiovascular risk, and avoiding medications that may worsen glucose or lipid metabolism. In addition, patients should be screened for diabetes-related complications. Such comprehensive management can slow the progression of complications and enhance the patients’ quality of life. Educating patients about their condition is a critical aspect of diabetes management, and it is vital to raise their awareness of this chronic disease. In the treatment of diabetic patients, knowledge and understanding are not just components of the therapy, but they are the therapy itself (Imam, 2013).

4. The Link Between PCOS and Diabetes

   1. Increased Risk of Diabetes in Women with PCOS:

      A cohort study conducted on 1,127 women where 4.7% met the criteria for PCOS between ages 20-32 years discovered that over the next 18 years, women with PCOS had a higher likelihood of developing diabetes (23.1% vs 13.1%), as well as dyslipidemia (41.9% vs 27.7%). The increased risk of developing hypertension was not statistically significant. Among normal-weight women, those with PCOS had a threefold higher chance of developing diabetes than those without (AOR 3.1). Women with persistent PCOS had the highest likelihood of developing diabetes (AOR 7.2) compared to those without PCOS. Women with polycystic ovary syndrome (PCOS) have an increased risk of developing diabetes and dyslipidemia, regardless of their body mass index (BMI). The risk of developing diabetes may be particularly high for those with persistent PCOS symptoms (Wang, et al., 2011).

   2. The Role Of Insulin Resistance In The Development Of Both PCOS and Diabetes:

      Research has shown that weight gain and obesity play a significant role in the development of PCOS, and this is partly due to the exacerbation of insulin resistance. The compensatory hyperinsulinemia that occurs in this context disturbs ovarian function by increasing androgen production and halting the development of ovarian follicles. Insulin resistance also contributes to the strong correlation between PCOS and adverse metabolic risks, including dysglycemia, dyslipidemia, and fatty liver disease. However, losing just 5% of body weight can significantly improve insulin sensitivity, resulting in meaningful improvements in hyper androgenic, reproductive, and metabolic symptoms.

      Type 2 diabetes mellitus is often characterized by hyperglycemia, which results from deficiencies in both insulin secretion and insulin action, also known as β-cell dysfunction and insulin resistance. Insulin resistance is a condition that reduces insulin sensitivity, leading to an inability of insulin to lower plasma glucose levels by suppressing hepatic glucose production and stimulating glucose utilization in adipose tissue and skeletal muscle. The degree of insulin resistance varies among individuals and can be attributed to genetic and environmental factors. Research has shown that increased insulin secretion can compensate for insulin resistance, while improved insulin sensitivity can conceal β-cell dysfunction

      (Thomas M Barber , Geroge K Dimitriadis, & Stephen Franks, 2016).

   3. The Impact of PCOS on Glucose Metabolism And Insulin Sensitivity:

      Polycystic ovary syndrome (PCOS) is a common condition affecting up to one in five women of reproductive age, with significant clinical implications including reproductive, metabolic, and psychological features. PCOS is known to have a significant impact on glucose metabolism and insulin sensitivity. Women with PCOS are at a higher risk of developing insulin resistance and impaired glucose tolerance, which can lead to an increased risk of developing type 2 diabetes and cardiovascular disease. The exact mechanism by which PCOS leads to insulin resistance is not yet fully understood, but it is believed to involve a combination of genetic, hormonal, and environmental factors. Women with PCOS who are overweight or obese may have a higher risk of developing insulin resistance and impaired glucose tolerance. Therefore, managing insulin resistance and improving glucose metabolism is an essential aspect of treating PCOS, which can lead to improved reproductive, metabolic, and psychological outcomes. This can be achieved through lifestyle modifications, such as weight loss, exercise, and dietary changes, and pharmacological interventions, such as insulin sensitizers and anti-diabetic medications

      (Fujimoto, 2000).

   4. The Impact of Diabetes on PCOS, Symptoms And Management:

      Polycystic ovary syndrome (PCOS) is a condition that affects both reproductive and metabolic health, and is closely linked to diabetes due to the common underlying factor of insulin resistance (IR). IR can cause elevated insulin levels, which may lead to increased androgen production by the ovaries, resulting in symptoms such as irregular periods, acne, and excess hair growth. Additionally, people with PCOS are at increased risk of developing type 2 diabetes, especially if they are overweight or have a family history of diabetes. For people with PCOS who also have diabetes, management can be more complex, as both conditions require careful monitoring and management of blood sugar levels, dietary changes, and medication to help regulate insulin levels. However, many approaches to managing diabetes can also be effective in managing PCOS symptoms, such as maintaining a healthy weight through a balanced diet and regular exercise. Medications used to manage diabetes, such as metformin, have also been found to be helpful in managing PCOS symptoms, especially when used in conjunction with lifestyle changes. It is important to closely monitor and manage both PCOS and diabetes to reduce the risk of complications and improve overall health outcomes. Addressing insulin resistance through therapeutic interventions is a key strategy in managing both conditions, and can help to ameliorate clinical features and reduce the risk of long-term complications such as diabetes

      (Helena Teede , Amanda Deeks, & Lisa Moran, 2010).

5. Conclusion:

1. Summary of Key Points:

   Polycystic ovary syndrome (PCOS) and type 2 diabetes are closely linked conditions due to the common underlying factor of insulin resistance (IR). IR can cause elevated insulin levels, leading to a range of symptoms and long-term complications in both PCOS and diabetes. People with PCOS are at an increased risk of developing type 2 diabetes, especially if they are overweight or have a family history of diabetes. Managing both PCOS and diabetes requires careful monitoring, dietary changes, and medication to regulate insulin levels. Approaches to managing diabetes, such as maintaining a healthy weight through a balanced diet and regular exercise, can also be effective in managing PCOS symptoms. Some medications used to manage diabetes, such as metformin, have also been found to be helpful in managing PCOS symptoms. Addressing insulin resistance through therapeutic interventions is a key strategy in managing both conditions and reducing the risk of long-term complications. Overall, close monitoring and management of both PCOS and diabetes is important to reduce the risk of complications and improve overall health outcomes.

2. The Importance Of Early Recognition And Management PCOS Associated Diabetes:

   The importance of early recognition and treatment for PCOS associated diabetes cannot be overstated. PCOS is closely linked to diabetes due to insulin resistance, which can lead to symptoms like irregular periods, acne, and excess hair growth. Individuals with PCOS are at increased risk of developing type 2 diabetes. Early intervention can prevent or delay complications like cardiovascular disease, infertility, and kidney damage. Treatment for PCOS associated diabetes includes lifestyle changes like maintaining a healthy weight and medication such as metformin. It is essential for individuals to work closely with their healthcare providers to develop a personalized treatment plan.

3. The Need For A Holistic Approach To Treatment, Addressing Both PCOS and Diabetes:

   A holistic approach to treatment is essential for addressing both PCOS and diabetes. Lifestyle modifications such as dietary changes, regular exercise, and stress management can improve insulin sensitivity and reduce the risk of complications. Pharmacological treatment like metformin may also be necessary, along with hormonal therapies to manage PCOS symptoms.

   Complementary and alternative therapies may be beneficial for some individuals. A comprehensive treatment plan must be developed with a healthcare provider, and regular monitoring is Important to ensure effectiveness. With careful management and ongoing support, individuals can live healthy, fulfilling lives.

4. Finals Thoughts And Recommendations For Future Research:

   Future research should continue to focus on understanding the complex relationship between PCOS and diabetes and developing more effective treatments. Specifically, research on the molecular mechanisms underlying PCOS and diabetes can provide insight into the pathophysiology of these conditions and identify new targets for pharmacological interventions.

   Additionally, studies on the long-term effects of specific treatments and their impact on health outcomes can help guide clinical decision-making. Lastly, it is important to raise awareness about PCOS and diabetes to improve early recognition and management. Education campaigns can help individuals recognize symptoms and seek medical care promptly, which can lead to better outcomes. With ongoing research and education, it is possible to develop more effective treatments and improve the lives of individuals living with PCOS and diabetes.

References: