What is the link between PCOS and Diabetes?

Timilehin Olaniyan BPharm, MPSN • April 14, 2023

What is the link between PCOS and Diabetes?

About 6-15% of women of childbearing age live with polycystic ovary syndrome (PCOS). More than half of this population will develop type 2 diabetes by 40, as revealed by the United States Centres for Disease Control and Prevention (CDC).

Scientists do not know the exact cause of PCOS, but research suggests that women with PCOS are insulin resistant.

Insulin resistance occurs when your cells don't respond to normal insulin levels, affecting their ability to convert blood glucose to energy. And insulin resistance is the primary cause of type 2 diabetes.

Approximately 70% of women with PCOS are insulin resistant.

However, that's not all. To fully make sense of the link between PCOS and diabetes, a brief overview of these conditions is necessary.

What is PCOS?

PCOS is a disorder of the hormonal and metabolic systems in women of childbearing age. It is one of the leading causes of infertility in women.

With PCOS, tiny fluid-filled sacs called cysts form around the ovary. This situation impairs ovulation and causes menstrual abnormalities.

"Just having ovarian cysts isn't enough for a diagnosis. Lots of women without PCOS have cysts on their ovaries, and lots of women with PCOS don't have cysts", according to the CDC.

Doctors base the diagnosis of PCOS on the presence of any 2 of these three symptoms:

Irregular menstruation or its absence
Higher-than-normal levels of male hormones
Several small cysts on the ovaries

What Causes PCOS?

Opinions are sharply divided on the exact cause of PCOS.

Some experts believe that the overproduction of the male sex hormone, testosterone, drives PCOS. Others argue for insulin resistance, while some investigators propose a multifactorial approach.

A range of evidence backs both schools of thought, making it difficult for experts to reach a consensus.

Doctors at the ENDO 2022 debate titled "PCOS: Who's Really Driving the Bus?" canvassed different positions.

"Insulin resistance leads to hyperinsulinemia, which drives the production of androgens", Dr. Ricardo Azziz, a professor of obstetrics and gynecology at the University of Alabama, states.

On the other hand, a professor of molecular medicine at the Icahn School of Medicine, Dr. Andrea Dunaif, argues that too much testosterone is the causal factor.

Explaining why everyone with type 2 diabetes doesn't get PCOS, Dr. Azziz revealed that PCOS is more than just insulin. "It's not sufficient to be just insulin resistant," he says.

Also, the CDC proposes that insulin resistance plays a pivotal role.

In addition to insulin resistance and excess androgen, Mayo Clinic lists heredity and low-grade inflammation as possible risk factors.

But Johns Hopkins says insulin resistance drives higher androgen levels.

As of today, the medical community agrees that the exact cause is unclear. More studies are needed to unravel this.

What are the symptoms of PCOS?

PCOS symptoms include

irregular periods: women with PCOS have fewer periods every year
weight gain: due to increased insulin level
excessive hair growth in unusual places
acne

How are PCOS and Type 2 Diabetes linked?

The relationship between PCOS and type 2 diabetes isn't fully understood. But most theories use insulin resistance to explain the link between these conditions.

With type 2 diabetes, your cells are resistant to insulin. Since insulin resistance has also been observed in PCOS patients, the risk of diabetes is about 3 to 8 times higher in people with PCOS.

Like type 2 diabetes, obesity or being overweight are risk factors for PCOS. Around 38-88% of women with PCOS are obese or overweight. The percentage is similar for diabetes.

Nevertheless, it's not known if obesity is a risk factor for developing diabetes in PCOS.

In the same vein, evidence suggests a higher risk of gestational diabetes mellitus (GDM) in patients with PCOS.

A study conducted in one Chinese hospital concluded that of the 196 PCOS patients that participated, about 24% had an incidence of GDM.

Below is a rundown of studies linking PCOS and diabetes.

A study that compared the risk of developing type 2 diabetes in women with PCOS and women without PCOS among Danish women found that the risk of developing type 2 diabetes is 4-fold in women with PCOS.

A 2014 Australian study that included women from the national health insurance database found a positive correlation between PCOS, T2DM, and GDM.

This review also found that PCOS and type 1 diabetes are associated. "Hence, screening for PCOS and androgen excess should be included in current guidelines for managing type 1 diabetes in women," the authors noted.

How to co-manage type 2 diabetes and PCOS?

Lifestyle modification is the best approach to co-managing both diseases. Regular exercise and a balanced diet are often recommended.

Diet: Foods with high glucose values worsen insulin resistance and should be avoided. Avoid sweetened beverages, fruit juice, trans fat, and dried fruit if you have these conditions.

Carbs like broccoli and whole fruit are healthier because they are fiber-rich. Opt for a diet with high nutrients, low fat, and calories.

Shed excess weight: Obesity and being overweight complicates PCOS and diabetes. It has been found that fat deposition in the mid-section plays the highest role.

A 5-7% weight reduction is beneficial. You should also note that diet plays a role in your weight loss journey, so go for food that aid weight loss.

Regular exercise: Exercise increases insulin sensitivity and helps you cut excess weight. Beneficial exercises include brisk walking, bicycling, and swimming.

What is the takeaway?

Women at risk should watch out for the symptoms of these diseases. Regular screening helps identify their symptoms and allows early detection.

Practice lifestyle modifications and talk to experts.

Sources:

Barber TM, et al. (2021). Obesity and polycystic ovary syndrome. DOI: doi.org/10.1111/cen.14421

Bjugstad (2022). Insulin and Androgens in Polycystic Ovary Syndrome: Which is the Causal Factor.

https://pro.endocrineweb.com/conference-news/insulin-and-androgens-in-polycystic-ovary-syndrome-which-is-the-causal

Escobar-Morreale HF, et al. (2016). Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis. DOI: doi.org/10.2337/dc15-2577

Glintborg D, et al. (2017). Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome. DOI: doi.org/10.1210/jc.2017-01354

Jamil AS, et al. (2014). A case-control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. DOI:

doi.org/10.1186/1742-4755-12-7

Joham AE, et al. (2014). Gestational Diabetes and Type 2 Diabetes in Reproductive-Aged Women With Polycystic Ovay Syndrome. DOI: doi.org/10.1210/jc.2013-2007

Li X, et al. (2021). The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome. DOI: doi.org/10.1097%2FMD.0000000000026521

Marshall JC, et al. (2012). Should all women with PCOS be treated for insulin resistance? DOI:

doi.org/10.1016/j.fertnstert.2011.11.036

Mayo Clinic Staff. (2017). Polycystic ovary syndrome (PCOS).

mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Polycystic ovary syndrome (PCOS) Fact sheet. (2018).

womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

Polycystic Ovary Syndrome.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

Author Bio:

Timilehin Olaniyan is a pharmacist who writes health and medical content. He leverages his training, experience, and practice to provide well-written content that educates professional and lay audiences. He believes bridging the communication gap in health information will help people make smarter health decisions. He aims to increase access to evidence-based health content. He has over seven years of experience and has earned the top-rated badge on Upwork. He enjoys playing and watching football.

Thank you for reading Patient Education Essentials, the Write Shift RN blog.

Disclaimer: This article was written as a guest post for Write Shift RN LLC's blog. The information in it may not be wholly fact-checked or edited, allowing the reader to see the writer's work and skills firsthand. This information is not intended as medical advice. It is for informational and educational purposes only. Always talk to your doctor or other qualified healthcare providers about any questions or concerns you may have regarding medical conditions.

< Older Post Newer Post >

Steroid Injections vs. PRP

By Kristina Van Winkle • October 7, 2024

A Comparative Overview for Pain Management Steroid injections and Platelet-Rich Plasma (PRP) injections are two commonly used pain management treatments. While both aim to alleviate pain and promote healing, they have different mechanisms of action and long-term effects . What Are Steroid Injections ? Corticosteroids are potent drugs used extensively across various medical fields to manage a broad spectrum of conditions, making them one of the most widely prescribed drug classes in the world. They can be administered via nearly every route, including direct injection into painful or inflamed joints. "Corticosteroids" typically refers to the class of drugs that produce glucocorticoid effects. Glucocorticoids are stress hormones that regulate numerous physiologic processes within the body. They have vasoconstrictive, immunosuppressive, and anti-inflammatory effects and play a role in metabolism. What do steroid injections treat? Corticosteroids function by suppressing the immune system and reducing inflammation within the body. They inhibit the production of the body's pro-inflammatory chemicals, leading to decreased inflammation and, consequently, pain. They are prescribed for hundreds of medical conditions, including: Allergic and autoimmune disorders Adrenocortical secretion disorders Infections and inflammation Pathologic hypoglycemia Organ and graft rejections Neurological disorders Hypercalcemia Blood disorders Skin disorders Shock What are the side effects of steroid injections? Although steroids are known to some as “wonder drugs,” they impact various bodily systems, including metabolism, water and electrolyte balance, the central nervous system, and blood cells. As a result, they are associated with many adverse side effects, especially when administered in large doses or over extended periods. Adverse effects may occur in up to 90% of individuals who take them for longer than sixty days. These side effects may include: Suppression of the hypothalamic-pituitary-adrenal axis Gastrointestinal disturbances Osteoporosis and fractures Psychiatric disturbances Carpal tunnel syndrome Cardiovascular disease Immunosuppression Cushingoid features Hyperglycemia Skin disorders Glaucoma Myopathy Cataracts Diabetes The risk of adverse side effects is particularly high when taken systemically. However, side effect occurrences vary when administered as local injections for pain management. Data indicates that steroid injections into joints and the spine can produce systemic effects that can last for weeks. When assessing the risk factors associated with steroid injections, healthcare providers must consider all types and doses of steroids the person is taking, including both oral and injectable forms. Additionally, special caution is advised for certain populations, such as those who may undergo surgery soon, postmenopausal women, and individuals with diabetes. What is Platelet-Rich Plasma (PRP) ? Platelet-rich plasma (PRP) injections use an individual's own blood to promote cellular regeneration. Through the extraction and reinjection of platelets, growth factors, and other bioactive proteins from the person's blood, PRP therapy offers long-lasting improvements, sustained pain relief, and enhanced tissue function. What do PRP injections treat? PRP injections can stimulate healthy cell growth, reduce inflammation, promote tissue repair, form new blood vessels, rejuvenate the skin and hair, and accelerate recovery after a traumatic injury. It can treat a wide range of conditions, including: Pain resulting from traumatic injury or degenerative conditions such as arthritis and chronic back pain Musculoskeletal conditions Tendinopathies and tears Compressive neuropathy Scars and stretch marks Osteochondral lesions Rheumatoid arthritis Erectile dysfunction Muscular injuries Plantar fasciitis Vaginal atrophy Osteoarthritis Epicondylitis Infertility Psoriasis Wounds Bursitis Vitiligo What are the side effects of PRP? Since PRP is derived from the person's own blood, the risk of allergic reactions or rejection is significantly lower compared to other injectables, such as steroids. PRP typically does not cause major side effects, though you may experience some soreness or bruising at the injection site. In rare cases, potential side effects may include: Tissue damage Nerve injuries Bleeding Infection Comparison of Steroid Injections and PRP Injections A study in the Journal of Orthopaedic Surgery and Research compared steroid injections with PRP injections in patients with mild to moderate symptomatic knee osteoarthritis (OA). The findings indicated that both treatments were safe and effective in improving short-term pain and functioning, with no significant differences observed. However, PRP therapy demonstrated superior outcomes in the long term, with benefits extending up to one year. Additionally, a literature review in Cureus Journal of Medical Science analyzed multiple studies comparing steroid injections with PRP in lumbar spondylosis and sacroiliac arthropathy. The review found that PRP was equally as effective, if not superior, to steroid injections in the short term. Neither treatment was associated with major complications, and there were no significant differences in minor complications between the two. The review concluded that both PRP and steroid injections are safe and effective for treating lumbar spondylosis and sacroiliac arthropathy, with some evidence that PRP may offer more benefits in the long term. Research has confirmed that both steroid and PRP therapy are valuable options for pain management and tissue healing. Steroid injections offer potent anti-inflammatory benefits that can provide immediate relief. However, their systemic side effects and limited duration of efficacy should be carefully considered, especially in high-risk populations. While PRP may take longer to show results, its long-term benefits make it an increasingly popular choice for treating various conditions. Ultimately, the choice between these treatments should be based on the specific needs of the individual patient, with careful attention to the patient's medical history. Thank you for reading the Write Shift RN blog. If you need an experienced RN writer for your health or healthcare educational content, contact me !