Background: The non-physiological ways and supraphysiological doses of insulin required for good glycemic control in patients with type 1 diabetes right from onset exposes them to effects of hyperinsulinism. In addition insulin resistance may be seen because of glucose toxicity and abnormal fat mass gain during puberty Insulin acts synergistically with luetinizing hormone to facilitate androgen production by theca.
Objective and hypotheses: To investigate the prevalence of polycystic ovary syndrome and its clinical profile in females with type 1 diabetes. Exogenous hyperinsulinism and insulin resistance may cause a polycystic ovary like profile in predisposed T1DM women.
Method: In this cross-sectional study 65 T1DM patients underwent clinical examination, hormonal evaluation for hyperandrogenemia and ultrasonography of the ovaries in the follicular phase of their menstrual cycle.
Results: Median age and duration of diabetes were 20 (range 1140) and 6 (range 1.527) years respectively. Median glycosylated haemoglobin was 7.15 (range 6.4511.06). Thirty eight subjects (63%) had pre-pubertal onset of diabetes. Eighteen of 60 patients (30%) satisfied the Rotterdam criteria for PCOS and 7(11%) the NIH criteria, prevalence which is much higher than 3.6% reported by us earlier in young women (1824 years age) from Lucknow. There was no difference in the clinical, anthropometric and biochemical parameters in patients with or without PCOS. In the subgroups of pre pubertal or post pubertal onset of diabetes, there were no difference in the levels of glycosylated haemoglobin, sex hormone binding globulin, and free androgen index, between the two groups, but the daily insulin dose in U/kg was higher in the post-pubertal group (1.05±0.21 in pre-pubertal vs 1.45±0.61 in post-pubertal; P value = 0.051).
Conclusion: Patients with type 1 diabetes have a high prevalence of menstrual irregularities, hyperandrogenism and PCOS which is not related to metabolic control or age of onset of diabetes.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology