title: Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome.
abstract: OBJECTIVE
  To 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).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Academic reproductive endocrinology practice.
  
  
  METHODS
  Adult women with PCOS (n = 111).
  
  
  METHODS
  None.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106-5034, USA. William.hurd@uhhospitals.org
authors.forename: William W
authors.initials: WW
authors.lastname: Hurd
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Abdel-Rahman
authors.forename: Salah A
authors.initials: SA
authors.lastname: Ismail
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Abdellah
authors.forename: Christine L
authors.initials: CL
authors.lastname: Schmotzer
authors.forename: Ajay
authors.initials: A
authors.lastname: Sood
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000175:diagnosis; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin