SAT-182 - Diabetes Screening Patterns in PCOS: A Population-Based Analysis of Administrative Health Data

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with a fourfold increase in the risk of developing type 2 diabetes. The 2023 International PCOS Guidelines advise routine diabetes screening for individuals with PCOS and identify the oral glucose tolerance (OGTT) as the preferred method for detecting dysglycemia. However, population-level data on diabetes screening practices in females with PCOS remained limited. This study examined diabetes screening patterns and factors associated with screening among females with PCOS in Alberta, Canada.

Methods: A retrospective cohort study was conducted using linked administrative health data from four Alberta provincial datasets from 2021-2023. The study population included females aged 18-45 years with PCOS without a diagnosis of diabetes. Validated case definitions were used to identify individuals with PCOS, diabetes, obesity, and hypertension. Diabetes screening tests included Hemoglobin A1c (HbA1c), Fasting Plasma Glucose (FPG), or OGTT. The primary outcome was the proportion of individuals screened. Secondary outcomes included the frequency of screening, the tests used, and factors related to screening, including whether comorbidities increased the likelihood of screening. Diabetes screening patterns were summarized using descriptive statistics, and logistic regression was used to examine the association between cardiometabolic comorbidities (hypertension and obesity) and diabetes screening.

Results: Among 11,153 individuals with PCOS without diabetes, 4,273 (38.3%) were not screened for diabetes per guidelines recommendations at least once over the 3-year period. Across 2021, 2022, and 2023, individuals underwent a median of 2 (IQR 2), 2 (IQR 2), and 1 (IQR 2) diabetes screening tests, ranging from 0-14, 0-18, and 0-22 tests per person, respectively. From 2021 to 2023, a total of 22,631 diabetes screening tests were completed, consisting of 11,791 (52.1%) HbA1C tests, 9,520 (42.1%) FPG tests, and 1,320 (5.8%) OGTTs. The odds of screening were higher among individuals with PCOS who had a diagnosis of hypertension (OR 1.55, 95% CI 1.25-1.78) or obesity (OR 1.45, 95% CI 1.32-2.60) compared with PCOS alone.

Conclusion: From 2021-2023, over one-third of individuals with PCOS did not receive the recommended diabetes screening, exposing a clear gap in care. Screening was more likely to occur when cardiometabolic risks co-existed with PCOS, despite PCOS being an independent sex-specific risk factor for diabetes. The low use of the OGTT further reflects poor adherence to guideline-recommended screening. These findings highlight a systemic shortfall that demands investigation into patient, provider, and health-system contributors.

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