Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Grupo de Diabetes, Obesidad y Reproducción Humana, Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Hum Reprod Update. 2022 Jun 30;28(4):501-517. doi: 10.1093/humupd/dmac011.
An increased prevalence of functional hyperandrogenism-including polycystic ovary syndrome (PCOS)-has been described in women with type 1 diabetes (T1D). However, heterogeneity between studies is frequent, and prevalence rates vary according to different criteria used for the diagnosis of PCOS and the population studied.
We aimed to perform a systematic review and meta-analysis of the prevalence of PCOS and related hyperandrogenic traits in premenopausal women with T1D. This way, we intend to increase the precision of the estimates of prevalence of PCOS and related traits in women with T1D, and to explore sources of heterogeneity while providing prevalence estimates for clinically relevant subgroups such as the different phenotypes.
We conducted a systematic review of the literature using Medline-OVID and Embase databases (Open Science Framework registry for systematic review protocols, https://osf.io/6cv9p/). Studies published up to 29 March 2021 were considered. We selected cross-sectional or prospective studies that reported, in patients with T1D, prevalence data on PCOS according to current definitions and different phenotypes, and/or prevalence rates of other related traits (hirsutism, hyperandrogenaemia, oligo-amenorrhoea and/or polycystic ovarian morphology: PCOM). Exclusion criteria for the review were studies addressing types of diabetes other than T1D; and studies using diagnostic definitions of PCOS different than those mentioned above. Two independent researchers performed data extraction. To assess the risk of bias, we used a tool developed specifically to appraise population-based prevalence studies.
We selected 19 studies (1042 women) reporting the prevalence of PCOS and/or other hyperandrogenic traits. Regarding bias, 12 studies were considered of low-risk, and the remaining seven studies were considered intermediate risk. The pooled prevalence of PCOS when considering all possible phenotypes (ESHRE- American Society for Reproductive Medicine criteria) in T1D was 26% (95% CI: 19-34%; 13 studies, 684 women). Pooled prevalence of classic PCOS (US National Institutes of Health criteria) was 16% (95% CI: 10-22%; 9 studies, 614 women). Pooled prevalence of hyperandrogenic PCOS (Androgen Excess and PCOS Society criteria) was 26% (95% CI: 16-41%; 5 studies, 329 women). Hirsutism (24%), hyperandrogenaemia (29%), oligomenorrhoea (24%) and PCOM (34%) were also prevalent. Heterogeneity was high in almost all these meta-analyses.
This systematic review and meta-analysis showed that PCOS and related hyperandrogenic traits are present in approximately one in every four women with T1D. Larger studies are needed to confirm this association, to address the effect of different variables on the occurrence of PCOS.
1 型糖尿病（T1D）患者中功能性高雄激素血症（包括多囊卵巢综合征[PCOS]）的患病率有所增加。然而，研究之间存在很大的异质性，患病率因用于 PCOS 诊断的不同标准和研究人群而异。
我们旨在对 T1D 绝经前妇女中 PCOS 及相关高雄激素特征的患病率进行系统评价和荟萃分析。这样，我们希望提高 T1D 妇女中 PCOS 及相关特征患病率的估计精度，并在提供不同表型等临床相关亚组的患病率估计值的同时，探讨异质性的来源。
我们使用 Medline-OVID 和 Embase 数据库（Open Science Framework 系统评价方案注册处，https://osf.io/6cv9p/）进行了系统文献检索。考虑了截至 2021 年 3 月 29 日发表的研究。我们选择了报告 T1D 患者中根据当前定义和不同表型以及（或）其他相关特征（多毛症、高雄激素血症、少经和/或多囊卵巢形态：PCOM）患病率数据的横断面或前瞻性研究。综述的排除标准为：研究对象为除 T1D 以外的其他类型糖尿病；以及使用不同于上述方法的 PCOS 诊断定义的研究。两名独立的研究人员进行了数据提取。为了评估偏倚风险，我们使用了专门用于评估基于人群的患病率研究的工具。
我们选择了 19 项研究（1042 名女性），报告了 PCOS 和/或其他高雄激素特征的患病率。关于偏倚，12 项研究被认为是低风险的，其余 7 项研究被认为是中风险的。考虑到所有可能表型（ESHRE-美国生殖医学学会标准），T1D 中 PCOS 的汇总患病率为 26%（95%CI：19-34%；13 项研究，684 名女性）。经典 PCOS（美国国立卫生研究院标准）的汇总患病率为 16%（95%CI：10-22%；9 项研究，614 名女性）。高雄性激素 PCOS（雄激素过多和 PCOS 学会标准）的汇总患病率为 26%（95%CI：16-41%；5 项研究，329 名女性）。多毛症（24%）、高雄激素血症（29%）、少经（24%）和 PCOM（34%）也很常见。这些荟萃分析中的大多数都存在高度异质性。
本系统评价和荟萃分析表明，大约每 4 名 T1D 绝经前妇女中就有 1 名患有 PCOS 和相关的高雄激素血症。需要更大的研究来证实这种关联，并解决不同变量对 PCOS 发生的影响。
