Phenotypic Variation of Insulin Resistance among Polycystic Ovarian Syndrome Patients in Semiurban North Indian Population

Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder in the women of reproductive age. Studies show that there is an intensive relationship between insulin and gonadal function. As per Rotterdam Criteria, there are four major phenotypes of PCOS with different presentation. Early detection of Insulin Resistance (IR) and consequential prevention of Metabolic Syndrome (MS) associated with PCOS may lead to better prospect for the disease. Aim: To find the pattern of IR in all the phenotypes of PCOS in relation to Waist Hip Ratio (WHR), Body Mass Index (BMI) and Testosterone and thereby, providing data for designing phenotype specific treatment of the disease. Materials and Methods: In this cross-sectional observational study, fasting insulin and fasting glucose were analysed to calculate Homeostasis Model Assessment (HOMA-IR) and Testosterone for total 144 female subjects of reproductive age group (18-40 years). Subjects were classified in to four groups as per Rotterdam Criteria. Complete PCOS (PCO-COM), PCO with Oligo/Anovulation (PCO-O), Anovulation with Hyperandrogenism (O-HA), and PCO with Hyperandrogenism (PCO-HA). Regression analysis was done to find the relation among the study variables. Analysis of Variance (ANOVA) was used to analyse the significant variance among the groups. Results: IR was found to be maximum among O-HA phenotype (2.4±0.37) and lowest among PCO-HA phenotypes (1.3±0.22). Regression analysis shows that there exist significant associations between IR and BMI (t=4.96, p=0.001) as well as between IR and WHR (t=2.97, p=0.003). No independent association between testosterone and IR was observed. Conclusion: Significant difference of IR, WHR, and BMI was observed among the four phenotypes of PCOS. Due to increased IR, O-HA and PCO-COM phenotypes are more predisposed to Cardiometabolic consequences of PCOS.