| Abstrakt: |
Women with type 1 diabetes mellitus (DMt1) have a higher incidence of menstrual and reproductive disorders with recent studies showing an increased incidence of the PCOS-like phenotype. Polycystic ovary syndrome (PCOS) is a leading cause of ovulatory dysfunction in women of active reproductive age. The Anti-Mèllerian Hormone (AMH) is a valuable diagnostic tool for PCOS and the most widely used biomarker for ovarian reserve in clinical practice. Determining its levels in women with DM1 would contribute to the better understanding of the pathogenetic mechanisms leading to ovarian dysfunction. Aim of the study: to perform a comperative analysis of AMH levels in women with DMt1 and clinically healthy women of similar reproductive age and BMI, as well as to assess the relation of the hormone with anamnestic, clinical and hormonal indices. Materials and methods: The study included 37 women with DMt1 and 38 clinically healthy women serving as a control group. The women with DMt1 were divided into 2 subgroups – with PCOS (n = 15) and without PCOS (n = 22). A detailed anamnesis was taken regarding the duration of diabetes, insulin administered, total daily insulin dose, gynecological history: including age at menarche, duration of the menstrual cycle (MC), dysmenorrhea, pregnancies, births, miscarriages. Anthropometric measurements and basal levels of AMH, testosterone (T), thyroid-stimulating hormone (TSH) and serum prolactin were studied in all participants. Body mass index (BMI), total daily insulin dose per kg body weight (TDD / kg) were calculated. Results: Serum levels of AMH as well as T were significantly higher in the DMt1 group compared to healthy controls (р=0,01, resp. p<0,001) at similar mean age (p = 0,26) and mean BMI (p = 0,57). When subdividing the group with DM1 into two subgroups – with and without PCOS and comparing them with healthy controls, there was again no significant difference in age and BMI (p = 0,20 vs. p = 0,85), serum levels of AMH and T remained significantly higher only in the subgroup with PCOS (p <0,001), while in the subgroup without PCOS they were comparable with those in the control group (p = 0,96, respectively p = 0,34). Women with DMt1 presented with a higher number of pregnancies (p = 0,005), births (p = 0,03) and miscarriages (p = 0,03). Only in the subgroup of DMt1 without PCOS, however, the frequency of pregnancies (p = 0,036) and births (p = 0,033) remained higher compared to the healthy controls. The relative share of women with dysmenorrhea was higher in the DMt1 group (51,4%) compared to controls (23,7%) (z-test, p <0,05). The group with DMt1 demonstrated positive correlations of AMH and T (p <0,0010), the presence of dysmenorrhea (p = 0,003) and the MC interval (p = 0,01) Although there is no statistically significant difference in the presence of dysmenorrhea and the interval of MC between women with DMt1 without PCOS and healthy controls, in this pathological subgroup there is still a positive relationship between the two variables (r=0,445, p=0,04). Conclusion: AMH was elevated in women with DMt1 only in the presence of a PCOS-like phenotype. Women with DMt1 without PCOS did not show significant differences in ovarian reserve and even had a higher number of pregnancies and births compared to healthy controls. The results of the present study determine the need for an in-depth assessment of the development of hyperandrogenic condition in women with DMt1 in the course of the insulin treatment leading to reproductive disorders. [ABSTRACT FROM AUTHOR] |
