Development of type 2 diabetes in adolescent girls with polycystic ovary syndrome and obesity.

Adult women with polycystic ovary syndrome (PCOS) and obesity have an 8-fold increased risk of developing type 2 diabetes (T2D). Our goal was to determine the incidence and risk factors for T2D in adolescents with PCOS and obesity. Retrospective chart review of girls aged 11-21 years with confirmed PCOS (oligomenorrhea and hyperandrogenism) diagnosis between 7/2013-8/2018 and at least one follow-up visit and BMI >85%ile. T2D incidence, defined with an HbA1c ≥6.5%, was calculated. A nested case-control study with 1:3 matching by race, ethnicity, and BMI was performed to determine predictors of T2D diagnosis. 493 patients with PCOS (age 15.6 ± 1.9 years, BMI 36.2 ± 6.3 kg/m2 ) were identified with a follow-up of 1018 person-years. 23 developed T2D (incidence 22.6/1000 person-years) with diagnosis a median of 1.8 years (2 months to 5.5 years) after PCOS diagnosis. T2D risk was higher in girls with a prediabetes HbA1c (5.7-6.4%) [HR 14.6 (4.8-44.5)] and among Hispanic girls with an elevated HbA1c and alanine aminotransferase [HR 19.0 (3.7-97.2)] at the time of PCOS diagnosis. In the 1:3 matched cohort, T2D risk was 18.7 times higher [OR 18.66 (2.27-153.24)] for every 0.1% increase in HbA1c at the time of PCOS diagnoses. Girls with PCOS and obesity have an 18-fold increase in T2D incidence compared to published rates in non-PCOS youth. Hispanic girls with elevated HbA1c and ALT are at particular risk. Due to the morbidity associated with youth onset T2D, these findings argue for better screening and prevention approaches in this population. This article is protected by copyright. All rights reserved.