PCOS raises diabetes risk in women, insulin resistance a key reason

Polycystic Ovary Syndrome, or PCOS, is usually linked only to irregular periods, acne, excess facial hair, weight gain and difficulty in pregnancy. But PCOS is not just a reproductive health issue. It also affects the body's metabolism, impairing the body's ability to manage sugar and raising the risk of type 2 diabetes. PCOS has recently been renamed Polyendocrine Metabolic Ovarian Syndrome, or PMOS.

Women with PCOS face a higher risk of prediabetes and type 2 diabetes compared to women without PCOS. According to recent studies, insulin resistance is a major metabolic feature of PCOS, and it can be found in about 70 percent of women with PCOS regardless of their body mass index (BMI).

The most important link between PCOS and diabetes is insulin resistance. Insulin is a hormone that carries sugar present in the blood to the body's cells, where it is used for energy. In many women with PCOS, the cells do not respond to insulin the way they should. As a result, the body has to produce more insulin to keep blood sugar levels under control. Over time, this system can become less effective, and blood sugar levels can gradually rise, starting as prediabetes and, in some women, eventually progressing to type 2 diabetes.

Insulin resistance can also worsen other PCOS-related problems, such as weight gain and hormonal imbalance. This can create a cycle in which hormonal and metabolic changes affect each other, leading to symptoms such as excess facial hair and irregular periods.

It is not necessary that every woman with PCOS will develop diabetes. It should be seen as a risk factor for diabetes. Some women's blood sugar levels never turn abnormal, while others may develop prediabetes or diabetes at a young age. Other factors that contribute to diabetes risk include excess weight, especially extra fat around the abdomen, a family history of type 2 diabetes, a sedentary lifestyle, poor dietary habits and high blood pressure. But women who have PCOS and are not overweight should also not assume they are not at risk of diabetes, because the link between PCOS and abnormal blood sugar can exist independent of weight.

Diabetes can develop gradually and show no clear symptoms in its early stages, which is why regular screening is important for women with PCOS. According to international guidelines on PCOS, blood sugar status should be checked after a PCOS diagnosis, and depending on the woman's own risk factors, re-testing can generally be done every one to three years. The Oral Glucose Tolerance Test, or OGTT, is considered the most accurate method to check how well a woman with PCOS handles sugar. Fasting and postprandial blood sugar tests and the HbA1c test are also useful. Which test is needed is decided by the treating doctor based on the woman's condition.

Regular physical activity is among the effective ways to reduce diabetes risk. Exercise helps the body use insulin better and allows muscles to use sugar more efficiently. A balanced diet with enough vegetables, fruits, protein, whole grains and fibre, along with reducing processed and sugary foods, can be beneficial. For women who are overweight, even modest, sustained weight loss can help improve metabolic health. A healthy diet, regular exercise, adequate sleep and long-term lifestyle changes play an important role in this. Doctors may also suggest medication for some women, based on their condition, to improve insulin sensitivity or manage other PCOS-related problems.

PCOS is not just a condition linked to periods, fertility or the ovaries; it can also affect metabolic health over the long term. Women with PCOS carry a higher risk of prediabetes and type 2 diabetes, making regular blood sugar checks and the right lifestyle important. With timely screening, healthy lifestyle changes and proper medical treatment, women can significantly reduce their risk of prediabetes and diabetes over time.