Disorders of the Glucose Metabolism Correlate With the Phenotype and the Severity in Women With Polycystic Ovary Syndrome

Josef van Helden; Osman Evliyaoglu; Andreas Küberl; Ralf Weiskirchen


Clin Endocrinol. 2020;93(1):44-51. 

In This Article

Materials and Methods

Study Group and Patients

This cross-sectional study was conducted between 2016 and 2018 in a single reference laboratory in Germany. The study group consisted of 130 reproductive age patients with PCOS and suspicion of impaired glucose metabolism, ranging from 19 to 44 years from various gynaecological practices and fertility centres located in North Rhine-Westphalia, Germany. The study group was divided into three subgroups with regard to glucose metabolism: patients with normal inulin sensitivity (IR−, n = 33), patients with insulin overstimulation (IO, n = 22) and patients with insulin resistance (IR+, n = 75). Patients included had (a) no history of gynaecological surgery, (b) normal thyroid function and (c) normoprolactinemia. Weight, height, cycle day and cycle length were obtained from order forms, fasting glucose, insulin 0, 60 and 120 minutes after 75 g glucose intake, C-peptide, intact proinsulin, adiponectin and CRP were measured for diagnostic purposes, and the HOMA-IR was calculated. After transferring the results to the study database, the samples were anonymized. AMH and sAMHR2 were measured as additional parameters. The AMH z -score and the sAMHR2/AMH ratio were calculated.

Assay Description

Serum samples were measured directly after arriving in the laboratory. Elecsys® AMH assay, insulin and C-peptide measurement were performed on a Roche Cobas 8000 modular analyser equipped with an e 801 immunoassay module according to the manufacturer's instructions, and plasma glucose and high-sensitive CRP were measured on a c 701 module (Roche). Intact proinsulin was measured with ELISA (Mediagnost), Adiponectin with ELISA (Tecomedical) and sAMHR2 with the Cusabio ELISA (Antikörper-online.de).

Impaired fasting glucose was defined as fasting glucose concentration >96 mg/dL in citrate-buffered blood plasma. The impaired glucose tolerance was defined as samples with 120 minutes plasma glucose in the range 140–199 mg/dL with fasting glucose values <126 mg/dL. Diabetes mellitus was present with plasma glucose >126 mg/dL and/or a 120 minutes glucose value >200 mg/dL. The physiological insulin course was considered to be insulin basal in the reference range, after 60 minutes less than 5 times the initial value, after that a drop, otherwise it was an inulin overstimulation.

Insulin resistance was defined as HOMA-IR >2.5, stimulated insulin values >100 mIU/L and/or increase of insulin by more than 10 times the initial value, and lack of sufficient normalization after 120 minutes.


Statistical analyses were performed using the statistical package SPSS 18.0 (SPSS Inc). Results were presented as mean ± SD (standard deviation). A P < .05 was considered significant. Normality of the distributions of all continuous variables was tested by the Kolmogorov–Smirnov test. Comparisons between two independent groups were done with the Mann–Whitney U test, while comparisons between dependent groups were done with the Wilcoxon signed rank test. Multiple comparisons between groups were performed by a nonparametric analysis of variance (ANOVA). Tukey test was applied for multiple comparisons in post hoc tests. Correlations between parameters determined with Spearman test.