Polycystic Ovary Syndrome (PCOS) is associated with metabolic diseases, including diabetes, and metformin is indicated if a1c is ≥5.7 demonstrating prediabetes/diabetes. To determine when to prescribe metformin, 2018 PCOS guidelines advise only an OGTT to screen, whereas ADA guidelines also include A1c. We sought to determine patterns of dysglycemia and metabolic disease in youth with PCOS and obesity. Data from girls (age 12-21 yrs, n=110) with obesity and untreated PCOS were examined. Metabolic assessments included fasting labs, 4-hour oral sugar tolerance test (OSTT, 75 g glucose, 25 g fructose) with Oral Minimal Modeling, liver fat assessment by MRI, and endogenous glucose release (Ra) with isotope tracers (N=31) . Data were divided by A1c (<5.7 vs. ≥5.7%) and compared by t-test. Pearson’s correlations were used to compare A1c to metabolic variables across the cohort. Prediabetes A1c was found in 27% (n=30, A1c 5.8±0.2% vs. n=80, A1c 5.3±0.2%) . Glucose concentrations, insulin sensitivity (IS) , and obesity related measures were worse with a1c≥5.7% and correlated with increasing A1c. Lower IS and higher liver fat were most strongly correlated to a1c. There were no differences in clinical or laboratory hyperandrogenism by A1c category, nor correlation with A1c (Table) . A1c testing is less burdensome than OGTT and can identify girls with PCOS and obesity at increased metabolic disease risk who may benefit from metformin.


E.Finn: None. Y.Garcia reyes: None. A.E.Taylor: None. A.L.Garfield: None. C.A.Vivas: None. K.Fuller: None. B.C.Bergman: Research Support; Eli Lilly and Company. K.J.Nadeau: None. M.Cree-green: None.


National Institutes of Health (R01DK120612) , (K23DK107871) , (UL1 TR002535) , (P30 DK048520) , (K12HD057022) ;Doris Duke Foundation (CDSA) , (CDSA COVID extension) , (2015212) ; Childrens Hospital Colorado; Boettcher Web Waring Foundation

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