Metabolic dysfunction in women with PCOS is more closely linked to BMI than to hyperandrogenism

Abstract

Introduction Polycystic ovary syndrome (PCOS) is frequently conceptualized as a hyperandrogenic disorder, yet cardiometabolic risk may be driven primarily by obesity and insulin resistance. We characterized glucose–insulin dynamics in women with PCOS and examined whether metabolic dysfunction was more closely associated with obesity status than with androgen-related parameters. Methods In this retrospective cross-sectional study, 71 women with PCOS underwent a standardized 3-hour oral glucose tolerance test (OGTT, 0–180 min) and were stratified by obesity status (BMI <30 kg/m², n=37; BMI ≥30 kg/m², n=34). OGTT-derived indices included the Matsuda index, HOMA-IR and AUCglucose(0–180). Associations were assessed using Pearson correlations and parsimonious multivariable linear regression models for log(Matsuda), log(HOMA-IR), and AUCglucose(0–180) including BMI, age and total testosterone as predictors. Results Obese women were older and had higher fasting glucose than non-obese women, whereas HbA1c was only numerically higher. During the OGTT, they showed higher glucose and insulin concentrations, lower insulin sensitivity, higher fasting insulin resistance, greater glucose exposure, and a higher insulin response relative to glucose exposure. PCOM prevalence, Rotterdam phenotype distribution, moderate-to-severe hirsutism and menstrual grades were similar between groups. Total testosterone and adrenal androgens were comparable. Across the parsimonious model, BMI was the only consistent independent predictor of log(Matsuda), log(HOMA-IR), and AUCglucose(0–180). Conclusions Within this PCOS cohort, metabolic impairment was more closely associated with BMI and obesity status than with the androgen-related parameters assessed. These findings support metabolic risk stratification in PCOS focused on obesity and insulin resistance rather than broader androgen-related markers.