REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
98
VOLUME 10 NUMBER 3 • SEPTEMBER 2013
Laboratory referral guidelines would need to reflect this and also
ensure that reporting detail is sufficient to base a diagnosis upon.
3. Standardisation of PCOS screening recommendation
PCOS is a common condition which identifies many women at
risk of CMD. Diabetes screening protocols for women with PCOS
need agreement. Fasting glucose will miss 80% of pre-diabetes
30
but
whilst the WHO45 and ADA4 now recommend the use of HbA
1C
to
diagnose diabetes they acknowledge the limitations of this test. This
includes the poor sensitivity in identifying IGR in PCOS, making the test
unsuitable for identifying small degrees of IGR in this population.
46
It
is noted, therefore, that despite a general move towards using HbA
1C
,
the OGTT remains the only proven test for accurate classification of
IGR and potentially for the diagnosis of type 2 diabetes in PCOS. For
this to work successfully in primary care settings, disease registers
and recall systems would be required to ensure that regular type
2 diabetes screening and CVD risk assessment can be undertaken.
Until there is formal UK guidance a pragmatic approach is required
to ensure that women with PCOS are recognised, diagnosed and
their CMD risk managed. European guidelines recommend screening
for diabetes in women with PCOS who have a BMI > 30 kg/m
2,28
despite evidence of profound insulin resistance in lean women with
PCOS47 and the guidance of screening PCOS with a BMI ≥ 25 kg/m
2
by the ADA.
3
Australian guidelines address this by recommending an
OGTT every two years on all women with PCOS or annually in those
with other risk factors including pre-existing IGR. Table 6 provides
suggestions for CMD assessment based upon information provided
by these sources (Table 6).
30
Standardisation of clinical assessment
The wide range of PCOS phenotypes and women’s own concerns
suggest that clinical management should be individualised according to
symptoms and risks. However, whether it is treating hyperandrogenism,
managing infertility or screening for CMD, it would be in the interests
of the woman involved and their healthcare professionals to have
evidenced-based guidelines to improve quality and equity of care.
Many of the issues raised in this article have been addressed recently,
although it should be noted that whilst adopting the Rotterdam
diagnostic criteria, the authors of the Australian guidelines
30
are not in
complete concordance with the recommendations of the 3rd ESHRE
consensus workshop
28
in terms of defining oligomenorrhoea and
recommendations to screen for CMD.
Conclusion
Whilst PCOS is a common condition it remains under-diagnosed
in primary care and its cardiometabolic consequences neglected.
Although controversies persist regarding diagnostic criteria and
the optimal screening and management guidelines for CMD,
relatively simple steps would improve the recognition of PCOS and
opportunities for primary prevention of CMD. General practitioners
and their teams are ideally placed to undertake this work and to
ensure that these women are no-longer disadvantaged.
Declaration of conflicting interest
The author declares that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in
the public, commercial, or not-for-profit sectors.
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