Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes

Key Points

Question  What is the prevalence of polycystic ovary syndrome (PCOS) among adolescents with type 2 diabetes (T2D)?

Findings  In this systematic review and meta-analysis involving 470 girls across 6 studies, the prevalence of PCOS was 19.58%, a prevalence that is substantially higher than that of PCOS in the general adolescent population.

Meaning  These findings suggest that PCOS is a common morbidity in girls with T2D, and it is critical that active screening for PCOS in girls with T2D is initiated at diabetes diagnosis and follows international evidence-based guidelines for diagnosing PCOS in adolescents.

Abstract

Importance  The prevalence of pediatric type 2 diabetes (T2D) is increasing globally. Girls with T2D are at risk of developing polycystic ovary syndrome (PCOS), but the prevalence of PCOS among girls with T2D is unknown.

Objective  To determine the prevalence of PCOS in girls with T2D and to assess the association of obesity and race with this prevalence.

Data Sources  In this systematic review and meta-analysis, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science: Conference Proceedings Citation Index–Science, and the gray literature were searched from inception to April 4, 2021.

Study Selection  Two reviewers independently screened for studies with observational study design that recruited 10 or more participants and reported the prevalence of PCOS in girls with T2D.

Data Extraction and Synthesis  Risk of bias was evaluated using a validated tool, and level of evidence was assessed using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was performed. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.

Main Outcomes and Measures  The main outcome of this systematic review was the prevalence of PCOS in girls with T2D. Secondary outcomes included assessing the associations of obesity and race with PCOS prevalence.

Results  Of 722 screened studies, 6 studies involving 470 girls with T2D (mean age at diagnosis, 12.9-16.1 years) met the inclusion criteria. The prevalence (weighted percentage) of PCOS was 19.58% (95% CI, 12.02%-27.14%; I² = 74%; P = .002). Heterogeneity was moderate to high; however, it was significantly reduced after excluding studies that did not report PCOS diagnostic criteria, leading to a calculated prevalence (weighted percentage) of 24.04% (95% CI, 15.07%-33.01%; I² = 0%; P = .92). Associations with obesity and race could not be determined because of data paucity.

Conclusions and Relevance  In this meta-analysis, approximately 1 in 5 girls with T2D had PCOS, but the results of this meta-analysis should be considered with caution because studies including the larger numbers of girls did not report the criteria used to diagnose PCOS, which is a challenge during adolescence. The associations of obesity and race with PCOS prevalence among girls with T2D need further evaluation to help define at-risk subgroups and implement early assessment and treatment strategies to improve management of this T2D-related comorbidity.