The Performance of Glycated Hemoglobin vs. Oral Glucose Tolerance Test in the Diagnosis of Glycemic Disorders among Women with Polycystic Ovary Syndrome in Southern Iraq

Mahmood Thamer Altemimi, Alaa Khattar Musa, Abbas Ali Mansour


BACKGROUND: Obese women with polycystic ovary syndrome (PCOS) are at high risk for developing type 2 diabetes mellitus (T2DM). A baseline oral glucose tolerance test (2-h OGTT) is important to screen for dysglycemia in PCOS particularly those high risk women. Due to its advantages by fasting is not required and less day-to-day variability, glycated hemoglobin (HbA1c) might be a convenient screening tool. This study aimed to evaluate the performance of HbA1c vs. 2-h OGTT in the diagnosis of glycemic disorders in PCOS and to evaluate the correlation between glycemic disorders, insulin resistance (IR), and anthropometric measures.

METHODS: One hundred and twenty nine women diagnosed with PCOS according to the Rotterdam 2003 criteria in Basrah were included in the study. All subjects were examined for weight, body mass index (BMI) and waist circumference (WC). Then they were tested for fasting glucose, 2-h OGTT, HbA1c, and fasting insulin to assess IR.

RESULTS: The result of 2-h OGTT test showed that there were 21 subjects (16.1%) showed to have IGT. The result of HbA1c test showed that 25 subjects (19.4%) were diagonised with prediabetes. Meanwhile FPG test result showed that 34 subjects (26.4%) were having IFG. The HbA1c examination showed an underdetected the diagnosis of T2DM (0.8%) and an overdeteced diagnosis of prediabetes (19.4%) (p=0.021) and at HbA1c 5.55% (37.2 mmol/mol), the specificity was (74.3%) and sensitivity (56.5%) to discriminate normal from abnormal glucose status. Ninety nine women (76.7%) were either overweight or obese and most of them had IR (76.8%).

CONCLUSION: Screening of glycemic disorders is crucial for PCOS by using 2-h OGTT regardless of risk factor and HbA1c seems to be an unsatisfactory screening tool to predict glycemic disorders in women with PCOS.

KEYWORDS: PCOS, glycemic disorders, OGTT, HbA1c, insulin resistance, and prediabetes

Full Text:



Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. American association of clinical endocrinologists, american college of endocrinology, and androgen excess and pcos society disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome--part 1. Endocr Pract. 2015; 21: 1291-300, CrossRef.

Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. American association of clinical endocrinologists, american college of endocrinology, and androgen excess and pcos society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome--part 2. Endocr Pract. 2015; 21: 1415-26, CrossRef.

DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. J Fertility Sterility Diabetes. 2005; 83: 1454-60, CrossRef.

American Diabetes A. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43 (Suppl 1): S14-31, CrossRef.

Rotterdam EA-SPCWG. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81: 19-25, CrossRef.

Pall M, Azziz R, Beires J, Pignatelli D. The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia. Fertil Steril. 2010; 94: 684-9, CrossRef.

Mansour AA, Al-Hassan AA, Al-Jazairi MI. Cut-off values for waist circumference in rural Iraqi adults for the diagnosis of metabolic syndrome. Rural Remote Health. 2007; 7(4): 765, CrossRef.

Alberti KGMM, Zimmet P, Shaw J. The IDF consensus worldwide definition of the metabolic syndrome. Diabet Med. 2006; 23: 469-80, CrossRef.

Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2018; 103: 1233-57, CrossRef.

Braunstein GD, Reitz RE, Buch A, Schnell D, Caulfield MP. Testosterone reference ranges in normally cycling healthy premenopausal women. J Sex Med. 2011; 8: 2924-34, CrossRef.

Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003; 9: 505-14, CrossRef.

Nordenstrom A, Falhammar H. Management of endocrine disease: Diagnosis and management of the patient with non-classic CAH due to 21-hydroxylase deficiency. Eur J Endocrinol. 2019; 180: R127-R45, CrossRef.

Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999; 84: 3666-72, CrossRef.

Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, De Francisco A, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013; 13: 47, CrossRef.

Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012; 33: 981-1030, CrossRef.

Ehrmann DA BR, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999; 22: 141-6, CrossRef.

Trakakis E, Basios G, Peppa M, Simeonidis G, Labos G, Creatsa M, et al. The prevalence of glucose metabolism abnormalities in Greek women with polycystic ovary syndrome. Gynecol Endocrinol. 2012; 28: 867-70, CrossRef.

Cowie CC, Rust KF, Byrd-Holt DD, Gregg EW, Ford ES, Geiss LS, et al. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006. Diabetes Care. 2010; 33: 562-8, CrossRef.

de Medeiros SF, Yamamoto MM, Bueno HB, Belizario D, Barbosa JS. Prevalence of elevated glycated hemoglobin concentrations in the polycystic ovary syndrome: anthropometrical and metabolic relationship in amazonian women. J Clin Med Res. 2014; 6: 278-86, CrossRef.

Mortada R, Comerford K, Kallail KJ, Karakas SE. Utility of hemoglobin-A1C in nondiabetic women with polycystic ovary syndrome. Endocr Pract. 2013; 19: 284-9, CrossRef.

Lerchbaum E, Schwetz V, Giuliani A, Obermayer-Pietsch B. Assessment of glucose metabolism in polycystic ovary syndrome: HbA1c or fasting glucose compared with the oral glucose tolerance test as a screening method. Human reproduction (Oxford, England). 2013; 28: 2537-44, CrossRef.

Holte J, Bergh T, Berne C, Berglund L, Lithell H. Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance. J Clin Endocrinol Metab. 1994; 78: 1052-8, CrossRef.

Picon MJ, Murri M, Munoz A, Fernandez-Garcia JC, Gomez-Huelgas R, Tinahones FJ. Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening. Diabetes Care. 2012; 35: 1648-53, CrossRef.

Celik C, Abali R, Bastu E, Tasdemir N, Tasdemir UG, Gul A. Assessment of impaired glucose tolerance prevalence with hemoglobin A(1)c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study. Hum Reprod. 2013; 28: 1062-8, CrossRef.

Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008; 93: 162-8, CrossRef.

Rahman MN, Diantini A, Fattah M, Barliana MI. Nutritional biomarkers for predicting pancreatic beta cell failure in central obesity. Indones Biomed J. 2021: 12: 19-26, CrossRef.

Wehr E, Gruber HJ, Giuliani A, Moller R, Pieber TR, Obermayer-Pietsch B. The lipid accumulation product is associated with impaired glucose tolerance in PCOS women. J Clin Endocrinol Metab. 2011; 96: E986-90, CrossRef.

Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a Prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999; 84: 165-9, CrossRef.

Nestler JE, Jakubowicz DJ, de Vargas AF, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab. 1998; 83: 2001-5, CrossRef.

Nestler JE, Powers LP, Matt DW, Steingold KA, Plymate SR, Rittmaster RS, et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab. 1991; 72: 83-9, CrossRef.


Indexed by:






The Prodia Education and Research Institute