The Effect of Polycystic Ovarian Syndrome on Development of Diabetes Mellitus by a Multistate Modelling Approach.

BACKGROUND

Women with polycystic ovary syndrome (PCOS) are more susceptible to metabolic dysfunction, especially glucose impairment. Previous studies have considered prediabetes (pre-DM) and diabetes mellitus (DM) as single-point outcomes without accounting for the transition states. This study aimed to explore the transition between different blood glucose states using a multistate Markov model among women with and without PCOS.

METHODS

This study employed a dataset from the population-based study of the Tehran Lipid and Glucose Study. Women, aged over 20 years, without pre-DM and DM at baseline (1999-2000) and with documented PCOS status, were included; subsequent follow-ups were conducted every 3 years, totaling six follow-up assessments. Three states of 'Normoglycemia', 'Pre-DM', and 'DM' and three possible transitions of (I) normoglycemia to pre-DM, (II) normoglycemia to DM, and (III) pre-DM to DM were defined. The multi-state Markov models were applied to examine the predictive effect of PCOS on the transition rates throughout the progression of DM.

RESULTS

Out of 1587 participated women, 782 (49.3%) remained free of pre-DM and DM at the end of the study. Transition from normoglycemia to pre-DM was the most frequent progression observed, affecting 46.6% of the study participants. Women with PCOS significantly had 23% higher hazard of transition I [HR (95% CI): 1.23 (1.01-1.49); p = 0.034] compared to those without PCOS. While being PCOS did not significantly affect the risk of other transitions.

CONCLUSIONS

This study underscores the significant impact of PCOS on the dynamic progression from normoglycemia to pre-DM. Future longitudinal studies are essential to support our findings.