Relationship between Androgen and Glucose Metabolism in Patients with Polycystic Ovary Syndrome

Abstract

Background Hyperandrogenemia is one of the most important clinical features of polycystic ovary syndrome (PCOS) and is closely related to metabolic syndrome. The related researches evaluating the relationship between androgen and type 2 diabetes mellitus and insulin resistance were not enough, and their results were inconsistent, thus not forming an unified scientific conclusion. Objective To investigate the changes of androgen level in PCOS patients with different glucose tolerance, and the relationship between androgen and glucose metabolism. Methods This study selected 954 PCOS patients in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2018 to December 2020, and collected data about androgen, 75 g glucose tolerance test and insulin release test. Body mass index (BMI), free androgen index (FAI) and homeostasis model insulin resistance index (HOMA-IR) were calculated. These patients were divided into normal glucose tolerance group (NGT), prediabetes group (IGT) and type 2 diabetes group (T2DM) according to the glucose tolerance status. PCOS patients were divided into Q1-Q4 subgroups based on the FAI quartile from low to high. PCOS patients were divided into normal (BMI<24.0 kg/m2), overweight (24.0 kg/m2≤BMI<28.0 kg/m2) and obesity subgroup (BMI≥28.0 kg/m2) according to BMI. This study compared the changes of androgen level, and the effects of androgen level on glucose metabolism in PCOS patients with different glucose tolerance, and analyzed the effect of androgen on insulin resistance. Results There were 490 patients in NGT group, 369 patients in IGT group and 95 patients in T2DM group. There were significant differences in BMI, FT, SHBG and FAI among these three groups (P< 0.01). Multiple linear regression analysis showed that T was a factor that affects Glu 30 min (β=0.068, P=0.037), Ins (β=0.098, P=0.002), HOMA-IR (β=0.086, P=0.008). SHBG and FAI were the factors that affect Glu 0 min, Glu 30 min, Glu 60 min, Glu 120 min, Glu 180 min, HbA1c (β=-0.187, 0.277, P< 0.001), INS (β=-0.226, 0.371, P<0.001), HOMA-IR (β=-0.224, 0.377, P<0.001). The levels of Ins 0 min, Ins 30 min, Ins 60 min, Ins 120 min, Ins 180 min and HOMA-IR of subgroup Q1-Q3 were significantly lower than that of subgroup Q4 (P< 0.05). FT (β=0.119, P=0.031) and SHBG (β=-0.155, P=0.005) were the factors that affect HOMA-IRin patients with normal weight. SHBG (β=-0.199, P<0.001) and FAI (β=0.249, P<0.001) were the factors that affect HOMA-IR in overweight patients. T, A, FT, SHBG and FAI are the factors that affect HOMA-IR (β=0.154, 0.132, 0.291, -0.176, 0.390, P<0.05) in obese patients. Conclusions T, SHBG and FAI had the impact on abnormal glucose metabolism in PCOS patients, and FAI had a more significant effect. High FAI increased insulin secretion. For PCOS women with different weight, the impact of androgens on HOMA-IR were different. Clinicians should provide the personalized glucose-lowering and androgen-lowering strategy to reduce the rates of related complications based on these factors.

Keywords

• polycystic ovary syndrome|androgens|free androgen index|insulin resistance|metabolism|root cause analysis