Few OB-GYNs screen women with a polycystic ovarian syndrome for blood sugar and cholesterol issues, despite recommendations to do so, according to a new survey published in the American Journal of Obstetrics & Gynecology, Reuters reports.
Background
As many as 12 percent of U.S. women have polycystic ovarian syndrome (PCOS), a hormone disorder that causes acne, irregular menstrual cycles and weight gain. PCOS, which can make it difficult for a woman to become pregnant, also puts a woman at higher risk for cholesterol and blood sugar problems.
The American Congress of Obstetricians and Gynecologists (ACOG) advises all women with PCOS to get their blood sugar levels tested every two to five years and their cholesterol levels tested every two years. According to Reuters, ACOG recommends a two-hour glucose tolerance test and a fasting lipid profile.
Key findings
The researchers conducted an online survey that yielded complete responses from 157 physicians. In the survey, the researchers asked OB-GYNs whether they ordered any tests during an initial visit with a woman presenting with PCOS. If so, the researchers asked which tests the providers ordered and what type of tests they would order as follow up.
According to the survey, about 22 percent reported that they would not order a test during the initial visit for at least 50 percent of their PCOS patients.
Moreover, the researchers found that providers most frequently used the hemoglobin A1C test to screen for blood sugar issues, which is less sensitive than the one recommended by ACOG, or fasting glucose tests. Overall, only 7 percent of respondents said they would order the two-hour glucose test for most of their PCOS patients during their initial visit. Only nine respondents said they usually order both a fasting lipid profile and two-hour glucose test during the first visit for most of their PCOS patients.
According to the survey, physicians cited the inconvenience of the two-hour glucose test for patients as the main reason for not ordering it. Moreover, more than 20 percent of respondents said results from such a test likely would not affect how they treat their patients.
The majority of respondents also said they would order a follow-up blood sugar test only if there was a change in the patient's medical history.
In contrast, participants' responses indicated great compliance with recommendations for cholesterol testing. According to the survey, 54 percent of physicians said they would order a fasting lipid profile for at least 50 percent of their PCOS patients. Seventy-six percent of respondents said they would order follow-up cholesterol tests even for patients with PCOS who presented with normal cholesterol.
Comments
Lead author Amy Dhesi of Kaiser Permanente Los Angeles Medical Center said, "Recognition of these abnormalities can allow the provider and the patient to work together to determine the next steps in health care improvement including nutritional changes and exercise, weight loss, starting a medication, and/or referral to a specialist."
Similarly, Richard Legro -- vice chair of research at Penn State University College of Medicine in Hershey who was not involved in the survey -- said, "Early detection can lead to prevention of developing diabetes and heart disease." He added, "Patients are more likely to change their lifestyle when they know they have a related abnormality."
Legro also noted that the follow-up tests are integral for monitoring changes in blood sugar or cholesterol levels and assessing whether the patient is responding to treatment (Kennedy, Reuters, 8/3).
