Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.
Diabetes Care. 2019 Apr;42(4):560-567. doi: 10.2337/dc18-1738. Epub 2019 Jan 31.
The nature of the independent relationship between polycystic ovary syndrome (PCOS) and type 2 diabetes remains unclear. Few studies have aimed to clarify this relationship independent of obesity in longitudinal population-based cohorts.
We used the Australian Longitudinal Study on Women's Health (ALSWH) (2000-2015) database to estimate nationwide incidence rates and predictors of type 2 diabetes among women aged 18-42 using person-time and survival analysis.
Over a follow-up of 1,919 person-years (PYs), 186 women developed type 2 diabetes. The incidence rate was 4.19/1,000 PYs and 1.02/1,000 PYs ( < 0.001) in PCOS and control subjects. On subgroup analyses across healthy-weight, overweight, and obese categories of women, the incidence rates for type 2 diabetes were 3.21, 4.67, and 8.80, whereas incidence rate ratios were 4.68, 3.52, and 2.36 ( < 0.005) in PCOS versus age-matched control subjects. PCOS was one of the most influential predictors for type 2 diabetes in the entire cohort (hazard ratio 3.23, 95% CI 2.07-5.05, < 0.001) adjusting for BMI, education, area of residence, and family history of type 2 diabetes.
Women with PCOS are at an increased risk of type 2 diabetes, irrespective of age and BMI. The incidence of type 2 diabetes increases substantially with increasing obesity; yet, PCOS adds a greater relative risk in lean women. Based on the overall moderate absolute clinical risk demonstrated here, guideline recommendations suggest type 2 diabetes screening every 1-3 years in all women with PCOS, across BMI categories and age ranges, with frequency influenced by additional type 2 diabetes risk factors.
多囊卵巢综合征（PCOS）与 2 型糖尿病之间独立关系的性质尚不清楚。很少有研究旨在在基于人群的纵向队列中独立于肥胖来阐明这种关系。
我们使用澳大利亚妇女健康纵向研究（ALSWH）（2000-2015 年）数据库，使用个人时间和生存分析来估计 18-42 岁女性的 2 型糖尿病全国发病率和预测因素。
在 1919 人年（PY）的随访中，186 名女性发生 2 型糖尿病。在 PCOS 和对照组中，发病率分别为 4.19/1000PY 和 1.02/1000PY（<0.001）。在健康体重、超重和肥胖组别的亚组分析中，2 型糖尿病的发病率分别为 3.21、4.67 和 8.80，而在 PCOS 与年龄匹配的对照组中，发病率比分别为 4.68、3.52 和 2.36（<0.005）。在整个队列中，PCOS 是 2 型糖尿病的最主要预测因素之一（风险比 3.23，95%CI 2.07-5.05，<0.001），调整 BMI、教育、居住地和 2 型糖尿病家族史。
患有 PCOS 的女性患 2 型糖尿病的风险增加，无论年龄和 BMI 如何。随着肥胖的增加，2 型糖尿病的发病率显著增加；然而，在瘦女性中，PCOS 会增加相对风险。基于这里显示的总体中度绝对临床风险，指南建议在所有 PCOS 女性中，无论 BMI 类别和年龄范围如何，每 1-3 年进行一次 2 型糖尿病筛查，频率受其他 2 型糖尿病危险因素的影响。
