Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in females of reproductive age and is increasingly being diagnosed in adolescence. Characterized by hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology, PCOS has far-reaching metabolic implications beyond reproductive dysfunction. One of the most significant metabolic disturbances associated with PCOS is insulin resistance (IR), a condition in which the body’s response to insulin is diminished, resulting in compensatory hyperinsulinemia [1,2].

The interplay between IR and PCOS creates a vicious cycle, with insulin acting as a co-gonadotropin to stimulate ovarian androgen production, thereby exacerbating hyperandrogenism and anovulation. Importantly, IR is a precursor to glucose intolerance, prediabetes, and eventually type 2 diabetes mellitus (T2DM), making adolescents with PCOS a high-risk population for early metabolic syndrome.

Several studies have highlighted that insulin resistance is present in up to 70% of women with PCOS, depending on diagnostic criteria and population studied. However, the metabolic profile of adolescents with PCOS, particularly in South Asian contexts such as Bangladesh, is less well-characterized. Given the region’s high background prevalence of diabetes and the socio-cultural barriers to early diagnosis, understanding these patterns is essential for timely intervention [3,4,5].

Adolescence is a critical window for intervention, as metabolic dysfunctions established during this period can persist into adulthood. Compounding this issue is the under-recognition of PCOS in younger populations, often dismissed as typical pubertal changes. Moreover, lifestyle factors such as poor diet, limited physical activity, and increased screen time have further exacerbated the risk of metabolic complications [6,7].

Despite the known risks, there is a lack of large-scale studies in South Asian adolescent populations assessing the prevalence of prediabetes, diabetes, and insulin resistance among those with PCOS. This study aims to fill that gap by evaluating a large cohort of adolescents with PCOS from various urban and rural settings across Bangladesh. The results are intended to guide early screening practices and preventive strategies aimed at curbing the growing epidemic of diabetes in young women.

Study Design and Participants This cross-sectional study was conducted from January 2017 to January 2018 in the department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh (BSMMU). The women who came to the the hospital for their routine healthcare were targeted. Upon signing the consent form by the PCOS woman and their legal guardian, they were Inclusion Criteria • Female adolescents aged 13–19 years • Diagnosed with PCOS based on the Rotterdam 2003 criteria • Informed consent from participants and legal guardians Exclusion Criteria • Known diagnosis of type 1 diabetes or other endocrinopathies • Use of hormonal or insulin-sensitizing medications in the past 6 months was reported in the study. • Pregnancy Data Collection and Laboratory Measures Participants underwent detailed interviews, physical examinations, and laboratory assessments. Anthropometric data included height, weight, BMI, and waist circumference. Blood samples were collected after an overnight fast to measure: • Fasting plasma glucose (FPG) • 2-hour post-load glucose (OGTT) • Fasting insulin • HOMA-IR (calculated as [Fasting insulin (μU/mL) × Fasting glucose (mmol/L)] / 22.5) Definitions • Prediabetes: FPG 5.6–6.9 mmol/L or 2-hour glucose 7.8–11.0 mmol/L • Diabetes: FPG ≥ 7.0 mmol/L or 2-hour glucose ≥ 11.1 mmol/L • Insulin Resistance: HOMA-IR >2.5 Statistical Analysis Data were analyzed using SPSS v26. Continuous variables were presented as means ± SD and categorical variables as frequencies or percentages. Associations between clinical parameters and metabolic outcomes were analyzed using chi-square tests and logistic regression models.