PCOS and hyperandrogenism in type 1 diabetes

Susan Tibuni-Sanders, Shahla Nader

Department of Internal Medicine, Endocrine Division, University of Texas at Houston, Houston, USA.

DOI: 10.4236/ojog.2012.21015                

Abstract

Women with both type 1 diabetes and polycystic ovarian syndrome (PCOS) represent a unique population, with long term implications on fertility and diabetic complications, which need to be addressed. The studies reviewed herein address the increased incidence of PCOS in women with type 1 diabetes. The leading theories suggest that the underlying pathophysiology is related to intensive insulin therapy and resulting ovarian hyperandrogenism. We have searched the literature to determine what studies have been done to address the role of insulin resistance and insulin sensitizers for reduction of hyperandrogenism in these patients. According to the available evidence, we conclude that metformin may have a role in reducing the androgenic picture in type 1 patients with PCOS and insulin resistance.

Keywords

Type 1 Diabetes Mellitus; Hyperandrogenism; PCOS; Metformin

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ehrmann, D. (2005) Medical progress: Polycystic ovarian syndrome. The New England Journal of Medicine, 352, 1223-1236. doi:10.1056/NEJMra041536
[2]	Strotmeyer, E., Steenkiste, M.S., Foley, S. and Dorman, J. (2003) Menstrual cycle differences between women with type 1 diabetes and women without type 1 diabetes. Diabetes Care, 26, 1016-1021. doi:10.2337/diacare.26.4.1016
[3]	Adcock, C.J., Perry, L.A., Lindsell, D.R., Taylor, A.M., Holly, J.M. and Dunger, D.B. (1994) Menstrual irregularities are more common in adolescents with type 1 diabetes: Association with poor glycemic control and weight gain. Diabetic Medicine, 11, 465-470. doi:10.1111/j.1464-5491.1994.tb00307.x
[4]	Escobar-Morreale, H.F., Roldan, B., Barrio, R., Alonso, M., Sancho, J., De la Calle, H. and Garcia-Robles, R. (2000) High prevalence of polycystic ovary syndrome and hirsutism in women with type 1 diabetes mellitus. Journal of Experimental and Clinical Medicine, 85, 4182-4187.
[5]	Codner, E., Soto, N., Lopez, P., Trejo, L., Avila, A., Eyzaguirre, F.C., Iniguez, G. and Cassorla, F. (2006) Diagnostic criteria for polycystic ovary syndrome and ovarian morphology in women with type 1 diabetes mellitus. Journal of Clinical Endocrinology & Metabolism, 91, 2250-2256.
[6]	Amin, R., Schultz, C., Ong, K., Frystyk, J., Dalton, R.N., Perry, L., Orskov, H. and Dunger, D. (2003) Low IGF-1 and elevated testosterone during puberty in subjects with type 1 diabetes developing microalbuminuria in comparison to normoalbuminuric control subjects: The Oxford Regional Prospective Study. Diabetes Care, 26, 1456-1461. doi:10.2337/diacare.26.5.1456
[7]	Shaw, L., Merz, N., Azziz, R., Stanczyk, F., Sopko, G., Braunstein, G., et al. (2008) Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: Results from the National Institutes of Health—National Heart, Lung, and Blood Institute sponsored women’s ischemia syndrome evaluation. Journal of Clinical Endocrinology & Metabolism, 93, 1276-1284.
[8]	Bolli, G.B. (2001) Physiological insulin replacement in type 1 diabetes mellitus. Experimental and Clinical Endocrinology & Diabetes, 109, S317-S332. doi:10.1055/s-2001-18591
[9]	Nestler, J. and Jakubowicz, D. (1996) Decreases in ovarian cytochrome P450c17 alpha activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. The New England Journal of Medicine, 335, 617-623. doi:10.1056/NEJM199608293350902
[10]	Longo, D., et al. (2011) Harrison’s principles of internal medicine. 18th Edition, McGraw-Hill, New York.
[11]	Lebovtiz, H.E. (2010) Adjunct therapy for type 1 diabetes mellitus. Nature Reviews Endocrinology, 6, 326-334. doi:10.1038/nrendo.2010.49
[12]	Baillargeon, J.P., Jean-Patrice, M.D. and Carpentier, A. (2007) Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity. Fertility and Sterility, 88, 886-893. doi:10.1016/j.fertnstert.2006.12.055
[13]	Codner, E., Mook-Kanamori, D., Bazares, R.A., Unanue, N., Sovino, H., Ugarte, F., Avial, A., Iniguez, G. and Cassorla, F. (2005) Ovarian function during puberty in girls with type 1 diabetes mellitus: Response to leuprolide. Journal of Clinical Endocrinology & Metabolism, 90, 3939-3945. doi:10.1210/jc.2005-0142
[14]	Holman, R., Paul, S., Bethel, A., Matthews, D. and Neil, H.A. (2008) 10-year follow up of intensive glucose control in type 2 diabetes. The New England Journal of Medicine, 359, 1577-1589. doi:10.1056/NEJMoa0806470
[15]	Dunaif, A., Segal K.R., Futterweit, W. and Dobrjansky, A. (1989) Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes, 38, 1165-1174. doi:10.2337/diabetes.38.9.1165
[16]	Hamilton, J., Cummings, E., Zdravkovic, V., Finegood, D. and Daneman, D. (2003) Metformin as an adjunctive therapy in adolescents with type 1 diabetes and insulin resistance. Diabetes Care, 26,138-143. doi:10.2337/diacare.26.1.138
[17]	Hermann, L.S. and Melander, A. (1997) Biguanides: Basic aspects and clinical uses. In: Herman, L.S., Ed., International Textbook of Diabetes Mellitus, Wiley John & Sons Inc., Chichester, 841-864.
[18]	Abdelghaffar, S. and Attia, A.M. (2009) Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents. Cochrane Database of Systematic Reviews, CD006691. doi:10.1002/14651858.CD006691.pub2
[19]	Sarnblad, S., Kroon, M. and Aman, J. (2003) Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: Randomized placebo-controlled trial with aspects on insulin sensitivity. European Journal of Endocrinology, 149, 323-329. doi:10.1530/eje.0.1490323
[20]	Vella, S., Buetow, L., Ryle, P., Lvingstone, S., Colhoun, H.M. and Petrie, J.R. (2010) The use of metformin in type 1 diabetes: A systematic review of efficacy. Diabetologia, 53, 809-820. doi:10.1007/s00125-009-1636-9