BACKGROUND An increased prevalence of functional hyperandrogenism—including polycystic ovary syndrome (PCOS)—has been described in women with type 1 diabetes (T1D). However, heterogeneity between studies is frequent, and prevalence rates vary according to different criteria used for the diagnosis of PCOS and the population studied. OBJECTIVE AND RATIONALE We aimed to perform a systematic review and meta-analysis of the prevalence of PCOS and related hyperandrogenic traits in premenopausal women with T1D. This way, we intend to increase the precision of the estimates of prevalence of PCOS and related traits in women with T1D, and to explore sources of heterogeneity while providing prevalence estimates for clinically relevant subgroups such as the different phenotypes. SEARCH METHODS We conducted a systematic review of the literature using Medline-OVID and Embase databases (Open Science Framework registry for systematic review protocols, https://osf.io/6cv9p/). Studies published up to 29 March 2021 were considered. We selected cross-sectional or prospective studies that reported, in patients with T1D, prevalence data on PCOS according to current definitions and different phenotypes, and/or prevalence rates of other related traits (hirsutism, hyperandrogenaemia, oligo-amenorrhoea and/or polycystic ovarian morphology: PCOM). Exclusion criteria for the review were studies addressing types of diabetes other than T1D; and studies using diagnostic definitions of PCOS different than those mentioned above. Two independent researchers performed data extraction. To assess the risk of bias, we used a tool developed specifically to appraise population-based prevalence studies. OUTCOMES We selected 19 studies (1042 women) reporting the prevalence of PCOS and/or other hyperandrogenic traits. Regarding bias, 12 studies were considered of low-risk, and the remaining seven studies were considered intermediate risk. The pooled prevalence of PCOS when considering all possible phenotypes (ESHRE- American Society for Reproductive Medicine criteria) in T1D was 26% (95% CI: 19–34%; 13 studies, 684 women). Pooled prevalence of classic PCOS (US National Institutes of Health criteria) was 16% (95% CI: 10–22%; 9 studies, 614 women). Pooled prevalence of hyperandrogenic PCOS (Androgen Excess and PCOS Society criteria) was 26% (95% CI: 16–41%; 5 studies, 329 women). Hirsutism (24%), hyperandrogenaemia (29%), oligomenorrhoea (24%) and PCOM (34%) were also prevalent. Heterogeneity was high in almost all these meta-analyses. WIDER IMPLICATIONS This systematic review and meta-analysis showed that PCOS and related hyperandrogenic traits are present in approximately one in every four women with T1D. Larger studies are needed to confirm this association, to address the effect of different variables on the occurrence of PCOS.

中文翻译：

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绝经前 1 型糖尿病女性 PCOS 和相关高雄激素特征的患病率：系统评价和荟萃分析

背景 1 型糖尿病 (T1D) 女性中功能性雄激素过多症（包括多囊卵巢综合征 (PCOS)）的患病率增加。然而，研究之间的异质性很常见，并且患病率根据用于诊断 PCOS 的不同标准和所研究的人群而有所不同。目标和基本原理 我们旨在对患有 T1D 的绝经前妇女的 PCOS 和相关高雄激素特征的患病率进行系统评价和荟萃分析。通过这种方式，我们打算提高 T1D 女性 PCOS 患病率和相关性状估计的准确性，并探索异质性的来源，同时为临床相关亚组（如不同表型）提供患病率估计。搜索方法 我们使用 Medline-OVID 和 Embase 数据库（系统审查协议的开放科学框架注册表，https://osf.io/6cv9p/）对文献进行了系统审查。考虑了截至 2021 年 3 月 29 日发表的研究。我们选择了横断面或前瞻性研究，这些研究在 T1D 患者中报告了根据当前定义和不同表型的 PCOS 患病率数据，和/或其他相关特征（多毛症、高雄激素血症、少闭经和/或多囊卵巢）的患病率形态学：PCOM）。审查的排除标准是针对除 T1D 以外的糖尿病类型的研究；以及使用与上述不同的 PCOS 诊断定义的研究。两名独立研究人员进行了数据提取。为了评估偏倚风险，我们使用了一种专门开发的工具来评估基于人群的患病率研究。结果 我们选择了 19 项研究（1042 名女性）报告 PCOS 和/或其他高雄激素特征的患病率。关于偏倚，12 项研究被认为是低风险的，其余 7 项研究被认为是中等风险的。考虑到 T1D 中所有可能的表型（ESHRE-美国生殖医学会标准）时，PCOS 的汇总患病率为 26%（95% CI：19-34%；13 项研究，684 名女性）。典型 PCOS（美国国立卫生研究院标准）的合并患病率为 16%（95% CI：10-22%；9 项研究，614 名女性）。高雄激素性 PCOS（雄激素过多和 PCOS 协会标准）的汇总患病率为 26%（95% CI：16-41%；5 项研究，329 名女性）。多毛症 (24%)、高雄激素血症 (29%)、月经稀发 (24%) 和 PCOM (34%) 也很普遍。几乎所有这些荟萃分析的异质性都很高。更广泛的意义 这项系统评价和荟萃分析表明，大约每 4 名 T1D 女性中就有 1 名存在 PCOS 和相关的高雄激素特征。需要更大规模的研究来证实这种关联，以解决不同变量对 PCOS 发生的影响。