Metabolic Screening in Patients With Polycystic Ovary Syndrome Is Largely Underutilized Among Obstetrician-Gynecologists EDITORIAL COMMENT

Women with polycystic ovary syndrome (PCOS) are at significantly increased risk of several metabolic abnormalities (insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome) and have substantially higher rates of these abnormalities compared with women without PCOS. Published guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) and Endocrine Society recommend that all women with PCOS undergo screening for impaired glucose tolerance and dyslipidemia (with a 2-hour, 75-g oral glucose tolerance test [OGTT] and fasting lipid profile upon diagnosis) and undergo repeat screening every 2 to 5 years and every 2 years, respectively. Tests for diabetes widely used for screening PCOS patients assess hemoglobin A(1c) and/or fasting glucose. However, both ACOG and Endocrine Society preferentially recommend the 2-hour OGTT in women with PCOS as a superior indicator of impaired glucose tolerance/diabetes mellitus. An online survey study was conducted to determine how often obstetrician-gynecologists order the appropriate metabolic screening tests in women with a diagnosis of PCOS. The survey was distributed in 2015 via e-mail to 300 ACOG fellows and junior fellows. Approximately 1 (22.3%) in 5 respondents would not order any PCOS screening test at the initial visit for at least 50% of their patients. The most common screening tests used to assess impaired glucose tolerance in women with PCOS were hemoglobin A(1c) (51.0%) and fasting glucose (42.7%). A fasting lipid profile would be ordered by 54.1% of respondents in 50% of their PCOS patients, but only 7% would order a 2-hour OGTT. These findings indicate that obstetrician-gynecologists do not routinely perform the 2-hour OGTT and lipid profile in patients with PCOS as recommended by ACOG and Endocrine Society guidelines. Underutilization of the ACOG and Endocrine Society guidelines is a missed opportunity for early intervention to minimize long-term morbidities. Increased efforts should be made to encourage obstetrician-gynecologists to address metabolic abnormalities in their patients with PCOS.