Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2022; 13(1): 5-26
Published online Jan 15, 2022. doi: 10.4239/wjd.v13.i1.5
Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review
Sarantis Livadas, Panagiotis Anagnostis, Julia K Bosdou, Dimitra Bantouna, Rodis Paparodis
Sarantis Livadas, Endocrine Unit, Athens Medical Centre, Athens 10563, Greece
Panagiotis Anagnostis, Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
Julia K Bosdou, Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
Dimitra Bantouna, Department of Pathology and Cytology, University of Patras School of Medicine, Patras 10563, Greece
Rodis Paparodis, Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH 23456, United States
Author contributions: All authors equally contributed to this manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sarantis Livadas, MD, PhD, Consultant Physician-Scientist, Endocrine Unit, Athens Medical Centre, M. Geroulanou 15, Athens 10563, Greece. sarntis@gmail.com
Received: April 20, 2021
Peer-review started: April 20, 2021
First decision: June 5, 2021
Revised: June 30, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: January 15, 2022
Abstract

Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities, such as insulin resistance. However, due to methodological flaws in the available studies and the multifaceted nature of the syndrome, there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated. The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS, the unique pathophysiological mechanisms underlying the progression of dysglycemia, the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population, as well as T2D risk after transition to menopause. Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided. Specifically, adoption of a healthy lifestyle with adherence to improved dietary patterns, such the Mediterranean diet, avoidance of consumption of endocrine-disrupting foods and beverages, regular exercise, and the effect of certain medications, such as metformin and glucagon-like peptide 1 receptor agonists, are discussed. Furthermore, the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.

Keywords: Polycystic ovary syndrome, Diabetes, Insulin resistance, Dysglycemia, Women

Core Tip: Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This review provides the most current knowledge on the different aspects of T2D in women with PCOS, including epidemiology, common pathophysiologic mechanisms, and methodology employed for dysglycemia assessment, as well as to scrutinize the risk factors for T2D development and to suggests the optimal management of these women in the context of T2D risk reduction.