Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome

ObjectiveTo compare screening strategies for type 2 diabetes mellitus (DM), impaired glucose tolerance (pre-DM), and insulin resistance (IR) in women with polycystic ovary syndrome (PCOS).DesignProspective study.SettingAcademic reproductive endocrinology practice.Patient(s)Adult women with PCOS (n = 111).Intervention(s)None.Main Outcome Measure(s)Subjects were screened for pre-DM and DM using a 2-hour glucose tolerance test (GTT), hemoglobin A1c (HbA1c), or fasting plasma glucose (FPG) and for IR using homeostasis model assessment (HOMA), insulin levels (fasting and 2 hours after 75 glucose load), or obesity. Screening approaches were compared using positive and negative percent agreement and Cohen’s kappa (κ).Result(s)DM and pre-DM were diagnosed by GTT in 4% and 20% of subjects, respectively. Screening with FPG failed to identify 41% of pre-DM and 20% of DM subjects. GTT and HbA1c had only fair agreement (κ = 0.29). IR was diagnosed in 24% of subjects with pre-DM or DM and in 56% of the remaining subjects using HOMA and insulin levels. HOMA and elevated insulin levels demonstrated substantial agreement for detecting IR (κ = 0.70–0.73). Obesity demonstrated fair to slight agreement (κ = 0.33–0.18).Conclusion(s)Women with PCOS should be screened for Pre-DM and DM using GTT or HbA1c, and those with Pre-DM or DM are presumed to have IR. In the rest, IR can be detected using either HOMA or insulin levels.