The Library
Polycystic ovary syndrome, combined oral contraceptives and the risk of dysglycemia : a population-based cohort study with a nested pharmaco-epidemiological case-control study
Tools
Kumarendran, Balachandran, O'Reilly, Michael W., Subramanian, Anuradhaa, Šumilo, Dana, Toulis, Konstantinos, Gokhale, Krishna M., Wijeratne, Chandrika N., Coomarasamy, Arri, Tahrani, Abd A., Azoulay, Laurent, Arlt, Wiebke and Nirantharakumar, Krishnarajah (2021) Polycystic ovary syndrome, combined oral contraceptives and the risk of dysglycemia : a population-based cohort study with a nested pharmaco-epidemiological case-control study. Diabetes Care, 44 (12). pp. 2758-2766. doi:10.2337/dc21-0437 ISSN 0149-5992.
|
PDF
WRAP-polycystic-ovary-syndrome-combined-oral-contraceptives-Šumilo-2021.pdf - Accepted Version - Requires a PDF viewer. Download (546Kb) | Preview |
Official URL: http://dx.doi.org/10.2337/dc21-0437
Abstract
OBJECTIVE: Irregular menstrual cycles are associated with increased cardiovascular mortality. Polycystic ovary syndrome (PCOS) is characterized by androgen excess and irregular menses; androgens are drivers of increased metabolic risk in women with PCOS. Combined oral contraceptive pills (COCPs) are used in PCOS both for cycle regulation and to reduce the biologically active androgen fraction. We examined COCP use and risk of dysglycemia (prediabetes and type 2 diabetes) in women with PCOS.
RESEARCH DESIGN AND METHODS: Using a large U.K. primary care database (The Health Improvement Network [THIN]; 3.7 million patients from 787 practices), we carried out a retrospective population-based cohort study to determine dysglycemia risk (64,051 women with PCOS and 123,545 matched control subjects), as well as a nested pharmacoepidemiological case-control study to investigate COCP use in relation to dysglycemia risk (2,407 women with PCOS with [case subjects] and without [control subjects] a diagnosis of dysglycemia during follow-up). Cox models were used to estimate the unadjusted and adjusted hazard ratio, and conditional logistic regression was used to obtain adjusted odds ratios (aORs).
RESULTS: The adjusted hazard ratio for dysglycemia in women with PCOS was 1.87 (95% CI 1.78–1.97, P < 0.001; adjustment for age, social deprivation, BMI, ethnicity, and smoking), with increased rates of dysglycemia in all BMI subgroups. Women with PCOS and COCP use had a reduced dysglycemia risk (aOR 0.72, 95% CI 0.59–0.87).
CONCLUSIONS: In this study, limited by its retrospective nature and the use of routinely collected electronic general practice record data, which does not allow for exclusion of the impact of prescription-by-indication bias, women with PCOS exposed to COCPs had a reduced risk of dysglycemia across all BMI subgroups. Future prospective studies should be considered for further understanding of these observations and potential causality.
Item Type: | Journal Article | ||||||||
---|---|---|---|---|---|---|---|---|---|
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Journal or Publication Title: | Diabetes Care | ||||||||
Publisher: | American Diabetes Association | ||||||||
ISSN: | 0149-5992 | ||||||||
Official Date: | December 2021 | ||||||||
Dates: |
|
||||||||
Volume: | 44 | ||||||||
Number: | 12 | ||||||||
Page Range: | pp. 2758-2766 | ||||||||
DOI: | 10.2337/dc21-0437 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Reuse Statement (publisher, data, author rights): | This is an author-created, uncopyedited electronic version of an article accepted for publication in Diabetes Care. The American Diabetes Association (ADA), publisher of Diabetes Care, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes Care in print and online at https://doi.org/10.2337/dc21-0437. | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 29 October 2021 | ||||||||
Date of first compliant Open Access: | 29 October 2021 | ||||||||
Related URLs: |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |
Downloads
Downloads per month over past year