Assessment of insulin resistance in lean women with polycystic ovary syndrome

Objective: To develop and validate a specific simple measure of insulin sensitivity using oral glucose tolerance test (OGTT) values for lean polycystic ovary syndrome (PCOS) women. Design: Retrospective study. Setting: Gynecologic Outpatient Clinic of University Hospital, affiliated with Unit of Gynecologic Endocrinology. Patient(s): Totals of 201 lean and 198 overweight/obese (ov-ob) nondiabetic PCOS patients were retrospectively selected. Intervention(s): None. Main Outcome Measure(s): All patients underwent OGTT, euglycemic-hyperinsulinemic clamp, and androgenic and biochemical assays. The predictive performance of each insulin resistance (IR) index was analyzed with the use of receiver operating characteristic (ROC) curves. Result(s): Higher correlation coefficients with clamp studies were obtained with the Belfiore Area (RS = 0.579) and the homeostasis-model assessment (HOMA)-M-120 (RS = -0.576) in lean PCOS patients and with the Sib (RS = 0.697) in ov-ob PCOS patients. The best predictive index of IR in lean PCOS was a HOMA-M-120 value of >= 12.8 or more (area under the ROC curve [AUC] 92.4%). In the ov-ob PCOS population, the best predictive performance was obtained by a Sib of <= 10.2 or less (AUC 85.7%). Conclusion(s): IR should be assessed in all PCOS women, both lean and ov-ob subjects. The HOMA-M-120 resulted as a very simple tool, validated specifically for the lean PCOS woman whose cardiometabolic impairment is more frequently misunderstood. (C)2014 by American Society for Reproductive Medicine.