Diagnostic accuracy of oral glucose tolerance tests, fasting plasma glucose and haemoglobin A1c for type 2 diabetes in women with polycystic ovary syndrome: A systematic review and meta-analysis

To inform international guidelines, a systematic review and meta-analysis was conducted to assess the performance of diagnostic methods for type 2 diabetes in women with polycystic ovary syndrome (PCOS). An updated systematic search was conducted on five databases from 2017 until October 2023 and co...

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Veröffentlicht in:Diabetes & metabolic syndrome clinical research & reviews 2024-03, Vol.18 (3), p.102970-102970, Article 102970
Hauptverfasser: Belsti, Yitayeh, Enticott, Joanne, Azumah, Rafiatu, Tay, Chau Thien, Moran, Lisa, Ma, Ronald C.W., Joham, Anju E., Laven, Joop, Teede, Helena, Mousa, Aya
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Sprache:eng
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Zusammenfassung:To inform international guidelines, a systematic review and meta-analysis was conducted to assess the performance of diagnostic methods for type 2 diabetes in women with polycystic ovary syndrome (PCOS). An updated systematic search was conducted on five databases from 2017 until October 2023 and combined with prior searches (from inception). Meta-analyses of diagnostic accuracy tests were conducted. Nine studies comprising 2628 women with PCOS were included. Against the oral glucose tolerance test, a haemoglobin A1C (HbA1c) ≥ 6.5% had a pooled sensitivity of 50.00% (95% confidence interval (CI): 35.53–64.47), specificity of 99.86% (95%CI: 99.49–99.98), and positive and negative predictive values of 92.59% (95%CI: 75.27–98.09) and 98.27% (95%CI: 97.73–98.68), respectively, with an accuracy of 98.17% (95%CI: 97.34–98.79). Fasting plasma glucose values ≥ 7.0 mmol/L had a pooled sensitivity of 58.14% (95%CI: 42.13–72.99), specificity of 92.59% (95%CI: 75.35–98.08), positive and negative predictive values of 92.59% (95%CI: 75.35–98.08) and 99.09% (95%CI: 98.71–99.36), respectively, and an accuracy of 99.00% (95%CI: 98.46–99.39) against the oral glucose tolerance test. To our knowledge, this is the first systematic review assessing the performance of diagnostic methods for type 2 diabetes in women with PCOS. We demonstrate that using a cut-off for HbA1c of ≥6.5% in this population may result in misdiagnosis of half of the women with type 2 diabetes. Our results directly informed the recommendations of the 2023 International PCOS Guideline, suggesting that the oral glucose tolerance test is the optimal method for screening and diagnosing type 2 diabetes in women with PCOS and is superior to fasting plasma glucose and HbA1c. •The optimal diagnostic test for screening and detecting type 2 diabetes in polycystic ovary syndrome is currently unknown.•We conducted the first meta-analysis examining type 2 diabetes diagnostic tests in women with polycystic ovary syndrome.•Using a cut-off for haemoglobin A1c of ≥6.5% in this population may misdiagnose half of the women with type 2 diabetes.•The oral glucose tolerance test is the most optimal method for detecting type 2 diabetes in polycystic ovary syndrome.•If other tests are to be used, fasting plasma glucose is more sensitive than haemoglobin A1c at the standard cut-off point.
ISSN:1871-4021
1878-0334
DOI:10.1016/j.dsx.2024.102970