Diagnostic criteria for polycystic ovary syndrome and ovarian morphology in women with type 1 diabetes mellitus
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Context: The criteria for diagnosis of polycystic ovary syndrome (PCOS) have been modified and now include polycystic ovary morphology (PCOM). Objective: The purpose of this study was to determine the frequency of PCOS and PCOM in women with type 1 diabetes mellitus (DM1). Design: We evaluated the clinical, hormonal, and ultrasonographic characteristics in women with DM1 and compared them with a carefully matched group of normal women in a cross-sectional study. Setting: The study was conducted at an academic research institute located within a general hospital. Patients: All the women with DM1 attending our hospital who had experienced menarche at least 2.5 yr earlier were invited to participate and were compared with healthy women with regular menses and without a history of hyperandrogenism [controls (C)]. Results: Hirsutism was present in 28.6 and 0.0% of DM1 and C, respectively (P < 0.001). Biochemical hyperandrogenism was present in 23.8 and 7.9% of DM1 and C, respectively. DM1 women had higher levels of testosterone and androstenedione and larger ovarian volume and follicle number by ovary than C. PCOM was present in 54.8% of DM1 and 13.2% of C (P < 0.001). Oligomenorrhea was present in 19% of women with DM1. The frequency of PCOS was 40.5 and 2.6% in DM1 and C, respectively (relative risk, 15.4; 95% confidence interval, 2.2-110.2; P < 0.0001). The proportion of women using intensive insulin treatment was higher in those with PCOM/PCOS (P < 0.05). Intensive treatment was a significant factor over having PCOM/PCOS (P < 0.05). Conclusions: A high frequency of hyperandrogenism, PCOM, and PCOS is observed in DM1, which appears to be associated with intensive insulin treatment.