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Reproductive Endocrinology

SUN-167 - The Additive Value of Oral Glucose Tolerance Test Shape in the Pathophysiology of Women with Polycystic Ovary Syndrome. Evidence from A Large European Cohort.

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Rodis D. Paparodis, MD, FNLA: .NovoNordisk: Advisory Board (), Speakers' Bureau (); Ascendis Pharma: Advisory Board (), Grant Recipient (), Honorarium Recipient (); Sanofi: Advisory Board ()


Background: Emerging data have shown that the shape of the glucose response curve during oral glucose tolerance test (OGTT) provides useful insights into insulin dynamics. A monophasic shape is defined as a simple increase to a peak with a subsequent decrease, whereas the biphasic shape was defined as a rise followed by a decrease and a subsequent increase ≥4.5 mg/dL after the decline in glucose. However, the impact of these patterns, if any, on the pathophysiology of polycystic ovary syndrome (PCOS) has not been fully elucidated yet.
Aim of the study: To assess the association of OGTT shape with metabolic and hormonal profile in women with PCOS.

Methods: Data from 1,328 women with PCOS with a mean age of 27.0 years (21–32) and BMI 26.7kg/m² (21–32) were analyzed and findings are presented before and after adjustment for age, BMI and area under the curve for glycemia (AUC).

Results: From the total group 461 subjects (34.7%) demonstrated a biphasic glucose response. The prevalence of impaired glucose tolerance (IGT) was higher in the biphasic group (20 vs.15%, p:0.015), as well as testosterone levels (2.70 vs. 2.58 mmol/L, p:0.01) while HOMA-IR values, hormonal and lipid parameters were comparable among subgroups. Biphasic group was characterized by substantially lower glucose concentrations at 30-90’ and higher 120’ glucose levels, resulting in lower total glucose exposure (AUC₀–₁₂₀) and markedly different late-phase slopes (ΔGLU60–90 and ΔGLU90–120), after adjustment for age and BMI. After adjustment for age and BMI the biphasic OGTT pattern remained strongly associated glucose values (30–90 min) and lower AUC₀–₁₂₀, while exhibiting higher 120-minute glucose and it was also associated with higher odds of IGT. The favorable association of a biphasic response with lower glycemia was stronger at younger ages and progressively attenuated with increasing age (p: 0.0026). also, an inverse relationship between AUC with increasing BMI was observed. Considering androgens, association between biphasic OGTT pattern and testosterone (p:0.002), free androgen index (p:0.036) and DHEAS (p:0.047) levels were disclosed after adjustment for age, BMI and AUC.

Conclusions: In this cohort the presence of a biphasic OGTT is associated with a distinct metabolic and hormonal profile. In fact, those with biphasic OGTT exhibited lower early and mid-phase glucose values and lower total glucose exposure, accompanied by higher prevalence of IGT. However, younger age and normal weight are associated with less glycemic load. Furthermore, biphasic OGTT even after adjustment for age, BMI, and total glucose exposure was independently associated with higher androgen bioavailability. This finding suggests a potential link between OGTT glucose dynamics and steroidogenic regulation in PCOS.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*