This research examined health records from approximately 400 hospitals across the United States, which focused on women aged 25 to 55 years. A total of 42,030 women diagnosed with PCOS between 2000 and 2020 were compared with two separate control groups, where one comprised of 84,060 women without PCOS matched by age, ethnicity, geography, and body mass index (BMI), and a second comprised of 42,030 women matched on all factors except BMI.
PCOS diagnoses were confirmed through ICD-coded records, while T2DM diagnoses were identified using both ICD codes and Hemoglobin A1c (HbA1c) levels. Within 3 years, 9.2% of women with PCOS developed T2DM, when compared to 6.0% in the matched non-PCOS group. After 15 years, the cumulative incidence rose to 34.3% among women with PCOS, against 22.6% in non-PCOS controls.
These results translate into an adjusted hazard ratio (HR) of 1.47, where women with PCOS were nearly 50% more likely to develop T2DM than those without the condition.
When the data were further analyzed across BMI categories, the elevated risk persisted regardless of weight class. Hazard ratios ranged from 1.37 in women with severe obesity (Class III) to 1.78 in women of normal weight. This suggests that PCOS itself, beyond weight, plays an independent role in elevating diabetes risk.
Also, the median BMI in the PCOS group was 34.86 kg/m², when compared with 27.26 kg/m² in non-PCOS controls who were not matched for BMI. This 7.6-point difference in BMI was associated with an additional hazard ratio of 1.87, indicating that excess body fat further amplifies diabetes risk beyond the hormonal and metabolic disruptions already linked to PCOS.
Overall, the findings highlight that women with PCOS undergo a dual burden of diabetes risk, one tied to the syndrome itself and another stemming from higher rates of obesity often associated with the condition.
Source:
Sharafutdinov, K., Hilpert, J., Burghaus, R., Diedrich, C., Lippert, J., Scheerans, C., & Schaper, S. (2025). Polycystic ovary syndrome and elevated body mass index independently increase type 2 diabetes risk with obesity-mediated risk dominating: a real-world data analysis of US patients. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2025.09.013
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