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Acta Médica Costarricense
On-line version ISSN 0001-6002Print version ISSN 0001-6012
Acta méd. costarric vol.54 n.4 San José Oct./Dec. 2012
Original
Determination of fasting plasma glucose cut-off valuefor the identification of abnormal carbohydratetolerance
in women with polycystic ovarian syndrome.
Yai-Linn Chang, Leonardo Orozco-Saborío,
Ileana Azofeifa-Hernández,
Gerardo Montiel-Larios
Clinical
research unit of the Women´s Hospital “Dr.
Adolfo Carit Eva”, CCSS.
Abbreviations: ADA, American
Diabetes Association; DM, Diabetes
Mellitus;
G2–HAL, Glucose two hours afterload; CIT,
Carbohydrate intolerance; SM, Metabolic Syndrome; PCOS, Polycystic
Ovary
Syndrome. Sources of support: Department of Endocrine Gynecology Women´s Hospital “Dr. Adolfo Carit Eva”. Costa Rican
Social
Insurance Fund.
Correspondence:
lorozco@ihcai.org
Abstract
Objective:
To determine the predictive value of fasting glucose to identify
abnormal
carbohydrate tolerance in patients with polycystic ovary syndrome.
Materials
and methods: 100 women
diagnosed with polycystic ovary
syndrome underwent a tolerance test toa 75
gdose of glucose.
Conclusions:
The current recommendations for diagnosing abnormal carbohydrate
tolerance in
women with polycystic ovary syndrome are not appropriate.
Keywords:
abnormal carbohydrate tolerance, polycystic ovary syndrome, screening.
to consult
medical advice, the insulin resistance and the hyperinsulinemia
are also common in them and have also an important etiologic role.
The
prevalence of Carbohydrate Intolerance (CIT) in
female with PCOS, Reaches up to 40%; five times the number expected in
healthy
women between 20-44 years all in the USA.With
respect
of Diabetes Mellitus type 2 (DM), its prevalence ranges between 8-12%
in these
population. These variations could be attributed to population
differences
corresponding to the patient´s origins,
among
others. In the same way, the association between CIT and metabolic
Syndrome (MS), is clearly established.
The
American Diabetes Association (ADA) indicates the
screening guidelines for the CIT in dose persons with any risk factors
to have
DM type 2, like women with PCOS. It is proposed only, to realize glycemic testing two hours afterload
75g of glucose (G2–HAL), to identify CIT in women
with PCOS, when fasting glycemia is higher
than 101
mg/dl (5,6 mmol/L). Similarly, The
Canadian Diabetes
Association recommends the use of these test
when the
fasting glucose is higher than 103 mg/dL
(5,7mmol/L).
However, even the evidence shows that measurement of fasting glucose is unreliable
predictor to identify CIT in PCOS women, the Canadian and American
Guidelines
based
The
objective of this research was to determinate the
predictive value of the thresholdcut
number of 101
mg/dL (5,6 mmol/L) of fasting glycemia
for
CIT patients with PCOS and stabilized an optimal screening level for
fasting
glucose in this population.
Materials
and methods
This
prospective descriptive study, took as population
patients with PCOS, captured in the Endocrine Gynecology consultation
in the
Inclusion
criteria were based in the PCOS diagnose
effectuated according under the guidelines
established in 2003, by the European Reproductive and Embryology
Society in
The CIT
and DM diagnosis was determined according to
We
measurement and weighted each participant in the
nursing cubicle on the HOMACE outpatient. Subsequently, as part of the
physical
medical exam, the specialist assistant of the Endocrinology Gynecology
consult,
had measurement the abdominal circumference (AC) with a metric standard
tape of
The
statistical analysis was realized with Stata
10.0 software. The variables were compared by means
of estimation of the t student test for quantities variables and the
homologue
Chi square for qualities variables; was defined statically significant,
a
critical point of 0,05 (p ≤ 0,05). The specificity, sensibility and the
positive and negative predictive values were generated with a data or
threshold
number of 101 mg/dl. A ROC (“receiver operating characteristic”)
curve was elaborated to define the most adequate threshold of fasting
glucose,
to identify abnormal tolerance of glucose.
Results
The
clinical and laboratory characteristics of the female
participants are summarized in Table
The mean
systolic and diastolic pressure was 126,8
mmHg and 82,6 mmHg, respectively, for the same group, a small
increase (Table 1)
compared with patients without abnormalities in tolerance.
Furthermore, the Hemoglobin Aic (means)
and fasting insulinemia concentrations,
were higher in CIT women, 5,2% vs 6,3% and
12,2%μUI/
mlvs26,6 μUI/ml
(normal values 5-15 μUI/ml)
respectively.
The
comparison of the other characteristic showed
significant differences between the groups of normal and abnormal
tolerance for
all the measurements; except for the presence of family history of DM,
Lipids
levels, androgens and thyroid function(p> 0,05; Table 1).
Discussion
Consider
the fact is very important, because it warns
about the possibility of not identifying PCOS patients and carriers
with CIT
when they get a fasting glycemia within
normal
limits, because an early tolerance diagnosis offers the possibility to
take
actions to prevent development of DM type 2.
Furthermore,
there was a clear increase of glycosylated
hemoglobin levels, and specially fasting insulinemia,
statistically significant in the glucose
intolerance group, adding the evidence that shows that PCOS patients
present
with a steady state of insulin resistant. These findings, together with
the
significant differences in BMI and tensional numbers for women with CIT
and
PCOS, reiterate to both pathologies as predisposing to suffer a higher
risk of
cardiovascular disease.
Regarding
independent predictive parameters for
carbohydrates intolerance in women with PCOS, according to the research
results, the family history of DM should not be consider predictive
factors,
because not reflect any relationship between their presence and CIT in
women
with PCOS.
Furthermore,
the ROC Curve identified a number of 93
mg/dl as optimum cutoff threshold with a sensibility of 75% and
specificity 73,7%. This sensibility number
falls below the ideal 80% for a
screening test. Furthermore, using this cut for realize the G2-HAL in
women
with PCOS, still yields an unacceptable 25% of intolerant women not
diagnosed.
Also, to
reach the 80% sensibility, would have to
accept a threshold cut of fasting glycemia
of
90mg/dl, generating the possibility of raise the positive false
percentage, and
unnecessary waste of recourses.
In
conclusion, just as has been demonstrated in
several publications with another type of populations, the fasting glycemia is not an important predictor factor
for the
carbohydrate intolerance identification in PCOSpopulation,what makes adequate contemplate
benefit-cost of
realize an G2-HAL to diagnose PCOS and then do it regularly, in order
to
prevent de development abnormal tolerance to carbohydrates or Diabetes
type 2.
Acknowledgments:
Special acknowledgment to the medical
residents Vladimir Gonzalez and Rodrigo Molina, as well as HOMAGE
Clinical
Laboratory personal, for their invaluable collaboration. There was no
conflict
interest by the authors of the study.
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