The Characteristic Of Daily Glucose Change In Different States Of Glucose Regulation With Polycystic Ovary Syndrome Women

Background Polycystic ovary syndrome(PCOS)was first reported by Professor Stein in 1930 s,along with the continuous improvement of people's living standard and life style changes,in recent years has become a common gynecologic endocrine disease complex disorders,its pathogenesis is not yet clear.PCOS in clinical manifestations can have menstrual disorder;hyperandrogenemia and polycystic ovary change,often suffered different levels of glucose and lipids metabolic disorder.Insulin resistance and hyperandrogenemia is considered the pathogenesis of initiating and central factors [1].Prevalence in patients with PCOS in women of childbearing age is about 7-10%,in infertility crowd accounts for about 40-60% [2],which is one of the causes of infertility.Even if PCOS patients successful pregnancy,PCOS women with IR are more likely to appear abnormal glucose tolerance and develop gestational diabetes and adverse pregnancy outcomes.In recent years,many studies have shown that women with PCOS have increased risk of developing diabetes mellitus,metabolic syndrome and cardiovascular disease [3].Blood glucose monitoring is the one of methods in diabetes treatment,but the traditional detection of fingertip blood and venous blood only reflect instantaneous blood glucose values;it cannot reflect the changes and trend of the blood glucose also cannot identify the hidden hypoglycemia or hyperglycemia.Continues glucose monitoring system(CGMS)is a major progress in blood glucose monitoring in recent years,it can reflect the blood glucose change trend in 24 hours,it could obtain signal from the probe every 10 seconds,and save the average of the signal every 5 minutes,a total of 288 blood glucose values can be recorded a day and continuous monitor patients' blood glucose levels for 72 hours.The advantage of CGMS is discovering the hyperglycemia and hypoglycemia events which could not found by traditional blood glucose monitoring.It can help doctors to analyze the changes of glucose fluctuations in tendency,amplitude,frequency,time,reasons and so on comprehensively.It is now widely used in patients with diabetes,it also used in insulin tumor,chronic kidney disease[4],cardiovascular disease and PCOS[5,6] have certain application,but the study of the characteristic of daily glucose change in different states of glucose regulation or different phenotypes in PCOS patients has little published.In this study,used CGMS monitors glucose in the PCOS patients in order to observe the characteristic of daily glucose change in different states of glucose regulation and to observe the effects of different metabolic parameters on blood glucose fluctuation and the characteristic of different phenotypes of PCOS patients in the same states of glucose regulation.Objectives The PCOS patients were divided into different states of glucose regulation according to the OGTT test.Used CGMS monitors glucose in the PCOS patients in order to observe the characteristic of daily glucose change in different states of glucose regulation and to observe the effects of different metabolic parameters on blood glucose fluctuation and the characteristic of different phenotypes of PCOS patients in the same states of glucose regulation.Methods Totally 87 cases of PCOS patients were selected in this study.The PCOS patients were divided into normal glucose tolerance(NGT)group,complex glucose impair(CGI)group and diabetes mellitus(DM)group according to the OGTT test.The metabolic parameters including body mass index(BMI),HOMA-IR index,together with the sex hormones were measured and compared.Continuous glucose monitoring system(CGMS)was used to monitor the glucose concentration of subcutaneous interstitial fluid so as to reflect the blood glucose level.Mean blood glucose level(MBG)and its standard deviation(SDBG),mean amplitude of glycemic excursion(MAGE),and coefficient variation(CV),to analyze the characteristics of glucose fluctuation in PCOS patients with different states of glucose regulation.The effects of different metabolic parameters on blood glucose fluctuation were observed in the same states of glucose regulation and the characteristic of blood glucose fluctuation in different phenotypes of PCOS patients in the same states of glucose regulation.Results 1.The results of different states of glucose regulation with PCOS patients: 39 patients were NGT patients(44.83%).31 patients in abnormal glucose tolerance(CGI)group(35.6%),17 patients in diabetes mellitus(DM)group(19.50%),the incidence of obesity in the patients was 31.03%(27/87).2.The comparison of metabolic indexes in different states of glucose regulation: The level of BMI in DM group and CGI group were higher than in NGT group(P<0.01,P<0.05);the level of Hb A1 c in DM group were significantly higher than NGT group(P<0.01);no different between CGI group and another two group;the level of LH were lower in DM group than in NGT group(P<0.05);the level of FSH and DHEAS were similar in three group;the level of SHBG were higher in NGT and CGI group than in DM group(P<0.05);the level of TT and FAI were similar in three group;?I30/?G30 in DM group were significantly lower than that of the NGT group and CGI group(P<0.01);the level of HOMA-? were similar in three group;HOMA-IR in another two group were significantly higher than NGT group(P<0.01).3.The comparison of metabolic indexes in different states of glucose regulation: The incidence rate of abnormal glycemic variability in NGT group was 38.46%(15/39),54.84%(17/31)in CGI group and 82.35%(14/17)in DM group,abnormal rate in DM group was higher than NGT group,no different between CGI group and the another two group.The incidence rate of one abnormality in NGT was higher than that in DM(P<0.05);while the incidence rate of three abnormalities in NGT was significantly lower than that in DM(P<0.05),no different between CGI group and another two group.4.The comparison of metabolic indexes in different states of glucose regulation: The levels of MBG in DM were significantly higher than that in NGT and CGI(P<0.01,P<0.05),no different between CGI group and NGT group;the levels of LAGE,MODD,SDBG,MAGE in different groups showed that: DM were significantly higher than that in NGT(P<0.05);there was no statistical difference in CGI between with NGT and DM;the level of CV were similar in three group.5.The correlation analysis showed that no correlation between in SDBG,MAGE,MODD,CV and Hb A1 c.SDBG was positively correlated with MAGE and MODD in each group.MBG was negatively correlated with ?I30/?G30 in CGI group(r =-0.37,P<0.05),SDBG was positively correlated with BMI in DM group(r =0.49,P<0.05).6.The study of the same states of glucose regulation: SDBG,MAGE level in NGT-abnormal blood glucose fluctuation group higher than in the NGT-normal blood glucose fluctuation group(P<0.05);MBG,SDBG,MAGE level in CGI-abnormal blood glucose fluctuation group significantly higher than in the CGI-normal blood glucose fluctuation group(P<0.01);the level of BMI in CGI-abnormal blood glucose fluctuation group higher than in the CGI-normal blood glucose fluctuation group(P<0.05),but the level of ?I30/?G30 in CGI-abnormal blood glucose fluctuation group lower than in the CGI-normal blood glucose fluctuation group;the level of MBG and BMI in DM-abnormal blood glucose fluctuation group higher than in the DM-normal blood glucose fluctuation group(P<0.05,P<0.01).Subgroup analysis of blood fluctuation and HOMA-IR based on FAI(?5 or <5)and have or no PCO there were no different in each group.Conclusion1.The prevalence of diabetes and obesity are far higher than the prevalence of diabetes in China in PCOS patients in this study.We should pay attention to screening for diabetes and even pre-diabetes in PCOS patients.2.In this study the PCOS patients in different states of glucose regulation,BMI increased,the early-phase insulin secretion gradually decreased,insulin resistance increased,and the SHBG level decreased.3.In this study,we found that with the gradual deterioration of the state of glucose regulation in PCOS patients,blood glycemic variability increased,from a single abnormal intraday glycemic variability,it gradually showed several abnormal intraday glycemic variability and even abnormal interday glycemic variability.4.Compared with the conventional OGTT test,CGMS can be used as a useful supplement to identify individuals at risk of metabolic disorders.SDBG can be used as a simple parameter to estimate the amplitude of glycemic variability besides MAGE and MODD.5.In the same states of glucose regulation we found the level of ?I30/?G30 in CGI-abnormal blood glucose fluctuation group lower but the level of BMI were higher than in the CGI-normal blood glucose fluctuation group and BMI in DM-abnormal blood glucose fluctuation group higher than in the DM-normal blood glucose fluctuation group,we haven't found hyperandrogenemia and PCO can directly affect blood glucose fluctuations.