Polycystic ovary syndrome (PCOS) is a common metabolic disorder
characterized by ovulatory dysfunction and hyperandrogenism. It is the
most common endocrine disorder in women of reproductive age and
affectsmore than 10% ofwomenworldwide,with those affected being at
increased risk of hirsutism, obesity, infertility, and abnormal glucose
metabolism. The prevalence of PCOS appears to be rising in many
countries, possibly as a result of the increasing prevalence of obesity [1].
Insulin resistance (IR) is commonly associatedwith PCOS and occurs
in both obese and non-obese women with this syndrome. Elevated
insulin levels stimulate ovarian androgen production, and this is
believed to have a causal role in both ovulatory dysfunction and
hyperandrogenism in women with PCOS [2]. Insulin resistance often
results in abnormal glucose metabolism, including pre-diabetes (defined
as impaired fasting glucose [IFG] and/or impaired glucose
tolerance [IGT]) and type 2 diabetes mellitus [3]. In the Arab region,
both diabetes and PCOS are increasing [4,5]. However, the prevalence of
diabetes and pre-diabetes in Arab women with PCOS is unknown. The
present studywas designed to determine the prevalence of diabetes and
pre-diabetes in a cohort of Arab women with PCOS.
In total, 179 women with PCOS (as defined in the Rotterdam
criteria [6]) attending 2 outpatient infertility clinics at the Qassim
College of Medicine, Qassim, Saudi Arabia, and Qena University
Hospital, Qena, Egypt, between June 15, 2009, and August 30, 2010,
were involved in the present prospective study. The study was
approved by the committees for ethics of research involving human
subjects in both centers, and all participants gave written informed
consent. Statistical analyses were performed using SPSS (SPSS,
Chicago, IL, USA). Continuous and categoric variables were compared
using t and χ2 tests, respectively. Pb0.05 was considered to be
statistically significant.
After fasting for 12 hours overnight, each woman underwent a
2-hour oral glucose tolerance test, which was performed using a 75-g
oral glucose load. Glucose and insulin levels were measured at 0 and
120 minutes after the oral ingestion of glucose. Normal glucose
tolerance, IFG, IGT, and diabetes were defined according to the criteria
in the 2003 American Diabetes Association guidelines [7]. The cut-off
points for IFG and IGTwere set between 5.6 and 6.9 mmol/L, and 7.8 and
11.0 mmol/L, respectively, and diabetes was diagnosed if fasting plasma
glucose exceeded 6.9 mmol/L or if values after 2 hourswere greater than
11.0 mmol/L.

The results indicated that abnormal glucose metabolism is very
common among Arab women with PCOS. Of the women in the present
study, 79 (44.1%) had abnormal glucose metabolism—more than 5
times as much as the 8% reported in Arab women of a similar age [5].
This result was not surprising, considering that 146 (81.6%) women
were either overweight or obese, and 87 (48.6%) had IR—all of which
are risk factors for abnormal glucose metabolism [3,8]. In addition,
women in the present study were more likely to have elevated
testosterone (n=122 [68.2%]) and IR than women with PCOS from
North America and the Mediterranean region [9,10]. Although the
basis of these differences is unclear, it is likely that they are the result
of genetic, environmental, and/or lifestyle factors.
In the present study, there was no difference in body mass index
(BMI, calculated as weight in kilograms divided by the square of
height in meters) between women with normal and women with
abnormal glucose metabolism (P=0.681; Table 1); however, abnormal
glucose metabolism was significantly more common in women
with a BMI of more than 30 (Pb0.02; Table 2). Abnormal glucose
metabolism in women with PCOS was more common among those
over 30 years of age (P=0.04), with a family history of diabetes
(P=0.04), and with IR (P=0.0001) (Table 2)—results that are
consistent with those indicated in studies from other regions [8]. By
contrast, abnormal glucose metabolism was not predicted by
hirsutism (P=0.75), amenorrhea/oligomenorrhea (P=0.27), or
elevated testosterone (P=0.36), probably because the majority of
women with PCOS share these characteristics. The 44.1% prevalence of
abnormal glucose metabolism (diabetes and pre-diabetes) found in
women in the present study is comparable to the 40% reported in
north European, North American, and Asian women with PCOS;
however, it is higher than the 20% reported in Australian women with
PCOS [3,8,11,12].
The relatively low (n=4 [2.2%]) prevalence of diabetes in the
present cohort is similar to that reported in women with PCOS from
Mediterranean countries; however, it is lower than the 10% prevalence
reported in women with PCOS from North America [8]. This is likely
to be a reflection of the relatively low mean age of the present cohort
(27 years), given that approximately 2% of women with pre-diabetes
will subsequently develop diabetes each year [3,8].
The findings of the present study support the recommendation
for initial and periodic screening for hyperglycemia and IR for
women with PCOS [6]. Because Arab women with PCOS are at
high risk of abnormal glucose metabolism, they should be evaluated
annually for diabetes, as recommended by the Androgen Excess and
PCOS Society [13].
Conflict of interest
The authors have no conflicts of interes