Indexes of Insulin Resistance in Hyperinsulinemic Polycystic Ovary Syndrome in a Macedonian Cohort of Women of Reproductive Age: A Cross-Sectional Study

Sasha Jovanovska-Mishevska; Aleksandra Atanasova-Boshku; Iskra Bitoska; Irfan Ahmeti; Biljana Todorova; Gordana Pemovska; Tatjana Milenkovic; Brankica Krstevska

doi:10.3889/oamjms.2016.107

Authors

Sasha Jovanovska-Mishevska University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Aleksandra Atanasova-Boshku University Clinic of Gynecology and Obstetrics
Iskra Bitoska University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Irfan Ahmeti University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Biljana Todorova University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Gordana Pemovska University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Tatjana Milenkovic University Clinic of Endocrinology, Diabetes and Metabolic Disorders
Brankica Krstevska University Clinic of Endocrinology, Diabetes and Metabolic Disorders

DOI:

https://doi.org/10.3889/oamjms.2016.107

Keywords:

insulin resistance, hyperinsulinemia, polycystic ovary syndrome, HOMA-IR, QUICKI

Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS) is complex hormonal, metabolic and reproductive disorder and is a leading cause of female infertility. Hyperinsulinemia secondary to insulin resistance plays important role in the pathogenesis of PCOS.

AIM: To assess the sensitivity of different indices of insulin resistance and their relevance in a clinical setting.

MATERIAL AND METHODS: A cross-sectional study of 43 patients with PCOS and 29 noromo ovulatory women as a control group was conducted. Standard clinical, anthropometrical and hormonal testing for hyperandrogenism was conducted, as well as oral glucose tolerance test with determination of basal and stimulated glucose and insulin values.

RESULTS: The dynamic I/G index showed the highest sensitivity and specificity, but the static indexes HOMA-IR and QUICKI, although based on only basal glycemic and insulinemic values, showed good sensitivity, 90.38% and 94.01% respectively. HOMA-IR showed significant positive correlation with the stimulated insulin values.

CONCLUSIONS: Our results support the use of static indexes in the evaluation of insulin resistance in women with PCOS in a clinical setting, offering a simple assessment of insulin resistance in PCOS, which holds great prognostic and treatment implications.

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References

Slowey MJ. Polycystic ovary syndrome: new perspective on an old problem. South Med J. 2001;94(2):190-6. http://dx.doi.org/10.1097/00007611-200194020-00004 PMid:11235033 DOI: https://doi.org/10.1097/00007611-200194020-00004

Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333(13):853-61. Erratum in: N Engl J Med. 1995;333(21):1435. http://dx.doi.org/10.1056/NEJM199509283331307 PMid:7651477 DOI: https://doi.org/10.1056/NEJM199509283331307

Futterweit W. Polycystic ovary syndrome: clinical perspectives and management. Obstetrical & gynecological survey. 1999;54(6):403-13. http://dx.doi.org/10.1097/00006254-199906000-00024 DOI: https://doi.org/10.1097/00006254-199906000-00024

Book CB, Dunaif A. Selective Insulin Resistance in the Polycystic Ovary Syndrome 1. The Journal of Clinical Endocrinology & Metabolism. 1999;84(9):3110-6. http://dx.doi.org/10.1210/jc.84.9.3110 DOI: https://doi.org/10.1210/jcem.84.9.6010

ESHRE TR, Group AS. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility. 2004;81(1):19-25. http://dx.doi.org/10.1016/j.fertnstert.2003.10.004 DOI: https://doi.org/10.1016/j.fertnstert.2003.10.004

Burghen GA, Givens JR, Kitabchi AE. Correlation of Hyperandrogenism with Hyperinsulinism in Polycystic Ovarian Disease. The Journal of Clinical Endocrinology & Metabolism. 1980;50(1):113-6. http://dx.doi.org/10.1210/jcem-50-1-113 PMid:7350174 DOI: https://doi.org/10.1210/jcem-50-1-113

Nestler JE, Jakubowicz DJ. Lean women with polycystic ovary syndrome respond to insulin reduction with decreases in ovarian P450c17 alpha activity and serum androgens. J Clin Endocrinol Metab. 1997;82(12):4075-9. PMid:9398716 DOI: https://doi.org/10.1210/jc.82.12.4075

Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38(9):1165-74. http://dx.doi.org/10.2337/diab.38.9.1165 PMid:2670645 DOI: https://doi.org/10.2337/diabetes.38.9.1165

Dunaif A, Thomas A. Current concepts in the polycystic ovary syndrome. Annual review of medicine. 2001;52(1):401-19. http://dx.doi.org/10.1146/annurev.med.52.1.401 PMid:11160786 DOI: https://doi.org/10.1146/annurev.med.52.1.401

SÃ¸rensen K, Aksglaede L, Munch-Andersen T, Aachmann-Andersen NJ, Petersen JH, Hilsted L, Helge JW, Juul A. Sex hormoneâ€“binding globulin levels predict insulin sensitivity, disposition index, and cardiovascular risk during puberty. Diabetes care. 2009;32(5):909-14. http://dx.doi.org/10.2337/dc08-1618 PMid:19196890 PMCid:PMC2671098 DOI: https://doi.org/10.2337/dc08-1618

Wallace IR, McKinley MC, Bell PM, Hunter SJ. Sex hormone binding globulin and insulin resistance. Clinical endocrinology. 2013;78(3):321-9. http://dx.doi.org/10.1111/cen.12086 PMid:23121642 DOI: https://doi.org/10.1111/cen.12086

Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHOâ€II anovulation and association with metabolic factors. BJOG: An International Journal of Obstetrics & Gynaecology. 2006;113(10):1210-7. http://dx.doi.org/10.1111/j.1471-0528.2006.01008.x PMid:16972863 DOI: https://doi.org/10.1111/j.1471-0528.2006.01008.x

Daniilidis A, Dinas K. Long term health consequences of polycystic ovarian syndrome: a review analysis. Hippokratia. 2009;13(2):90-2. PMid:19561777 PMCid:PMC2683463

PatarrÃ£o RS, Lautt WW, Macedo MP. Assessment of methods and indexes of insulin sensitivity. Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo. 2014;9(1):65-73. http://dx.doi.org/10.1016/j.rpedm.2013.10.004 DOI: https://doi.org/10.1016/j.rpedm.2013.10.004

Achard C, Thiers J. Le virilisme pilaire et son association a l'insuffisance glycolytique (diabete des femmes a barbe). Bull Acad Natl Med. 1921;86(29):51-66.

Kierland RR. Acanthosis nigricans: An analysis of data in twenty-two cases and a study of its frequency in necropsy material. Journal of Investigative Dermatology. 1947;9(6):299-305. http://dx.doi.org/10.1038/jid.1947.102 PMid:18918924 DOI: https://doi.org/10.1038/jid.1947.102

Dunaif A, Graf M, Mandeli J, Laumas V, Dobrjansky A. Characterization of Groups of Hyperaiidrogenic Women with Acanthosis Nigricans, Impaired Glucose Tolerance, and/or Hyperinsulinemia. The Journal of Clinical Endocrinology & Metabolism. 1987;65(3):499-507. http://dx.doi.org/10.1210/jcem-65-3-499 PMid:3305551 DOI: https://doi.org/10.1210/jcem-65-3-499

Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20â€“74 yr. Diabetes. 1987;36(4):523-34. http://dx.doi.org/10.2337/diab.36.4.523 PMid:3817306 DOI: https://doi.org/10.2337/diabetes.36.4.523

Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and sterility. 2002;77(6):1095-105. http://dx.doi.org/10.1016/S0015-0282(02)03111-4 DOI: https://doi.org/10.1016/S0015-0282(02)03111-4

Pesant MH, Baillargeon JP. Clinically useful predictors of conversion to abnormal glucose tolerance in women with polycystic ovary syndrome. Fertility and sterility. 2011;95(1):210-5. http://dx.doi.org/10.1016/j.fertnstert.2010.06.036 PMid:20655529 DOI: https://doi.org/10.1016/j.fertnstert.2010.06.036

Garruti G, Depalo R, Vita MG, Lorusso F, Giampetruzzi F, Damato AB, Giorgino F. Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment. Reproductive biomedicine online. 2009;19(4):552-63. http://dx.doi.org/10.1016/j.rbmo.2009.05.010 PMid:19909598 DOI: https://doi.org/10.1016/j.rbmo.2009.05.010

Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstetrical & gynecological survey. 2004;59(2):141-54. http://dx.doi.org/10.1097/01.OGX.0000109523.25076.E2 PMid:14752302 DOI: https://doi.org/10.1097/01.OGX.0000109523.25076.E2

Fulghesu AM, Angioni S, Portoghese E, Milano F, Batetta B, Paoletti AM, Melis GB. Failure of the homeostatic model assessment calculation score for detecting metabolic deterioration in young patients with polycystic ovary syndrome. Fertility and sterility. 2006;86(2):398-404. http://dx.doi.org/10.1016/j.fertnstert.2006.01.024 PMid:16769061 DOI: https://doi.org/10.1016/j.fertnstert.2006.01.024

Ducluzeau PH, Cousin P, Malvoisin E, Bornet H, Vidal H, Laville M, Pugeat M. Glucose-to-insulin ratio rather than sex hormone-binding globulin and adiponectin levels is the best predictor of insulin resistance in nonobese women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 2003;88(8):3626-31. http://dx.doi.org/10.1210/jc.2003-030219 PMid:12915646 DOI: https://doi.org/10.1210/jc.2003-030219

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. The Journal of Clinical Endocrinology & Metabolism. 2000;85(7):2402-10. http://dx.doi.org/10.1210/jcem.85.7.6661 PMid:10902785 DOI: https://doi.org/10.1210/jcem.85.7.6661