Polycystic ovary syndrome (PCOS) is associated with a higher prevalence of metabolic dysfunction, particularly disturbances in glucose metabolism. Prior studies commonly treated pre‑diabetes (pre‑DM) and diabetes mellitus (DM) as single end points rather than as a sequence of transitions. The present study used a multistate Markov model to examine how PCOS status predicts movement between discrete glycemic states over time, with the specific aim of evaluating whether PCOS alters transition rates from normoglycemia to pre‑DM and DM.
The analysis used data from the Tehran Lipid and Glucose Study. Eligible participants were women older than 20 years who were free of pre‑DM and DM at baseline (1999–2000) and had documented PCOS status. Follow‑up visits occurred approximately every 3 years, comprising six follow‑up assessments in total. The analytic cohort included 1,587 women.
Three mutually exclusive, time‑dependent states were specified for the multistate framework: Normoglycemia, Pre‑DM, and DM. The model evaluated three possible forward transitions:
This structure allows estimation of transition hazards and cumulative hazards for each leg of glucose dysregulation rather than treating progression as a single binary outcome.
The investigators applied multistate Markov models to quantify how PCOS status influenced transition rates between the defined glycemic states. This technique models the instantaneous hazard of moving from one state to another while accommodating repeated observations over serial follow‑ups. The approach distinguishes early progression (normoglycemia to pre‑DM) from later or direct progression to DM.
Of the 1,587 women in the cohort, 782 (49.3%) remained free of pre‑DM and DM by the end of follow‑up. The most frequent progression observed was from normoglycemia to pre‑DM (Transition I), which occurred in 46.6% of participants.
Comparing women with and without PCOS, the model estimated that PCOS was associated with a statistically significant increase in the hazard of Transition I. Specifically, women with PCOS had a 23% higher hazard of progressing from normoglycemia to pre‑DM compared with women without PCOS [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.01–1.49; p = 0.034].
PCOS status did not show a statistically significant association with the hazards for Transition II (Normoglycemia → DM) or Transition III (Pre‑DM → DM) in the reported results.
These findings emphasize that PCOS exerts a measurable effect on the earliest detectable step in glycemic deterioration—the shift from normoglycemia to pre‑diabetes. Framing progression as discrete transitions underscores that women with PCOS may be at elevated risk for the initial development of glucose impairment even if later transitions to DM were not demonstrably increased in this analysis.
Clinically, this supports vigilance in metabolic screening and early lifestyle or therapeutic interventions for women with PCOS to detect and potentially delay progression to pre‑DM. The results also demonstrate the value of multistate methods for disentangling stage‑specific risks during the natural history of glucose dysregulation.
The abstract reports key cohort sizes, transition frequencies, and a primary hazard ratio with confidence interval and p value, but additional methodological details and subgroup analyses are not presented in the abstract. The authors state that future longitudinal studies are needed to confirm these observations and to further characterize the influence of PCOS on subsequent transitions to diabetes.
Conflict of interest: the authors declared no conflicts of interest.
Note: this summary is derived from the published article abstract and figures as reported in the source. Additional analytic details, covariate adjustments, or sensitivity analyses that may appear in the full text were not reported in the abstract and therefore are not described here.