Researchers Urge for Additional Screening, Standard Diagnoses to Lower Overall Economic Burden The polycystic ovary syndrome (PCOS) - characterized by irregular menstrual cycles, infertility, ovarian cysts, increased risk for diabetes and obesity, and excessive hair growth (hirsutism), among other health problems - is the most common endocrine-related condition of reproductive-aged women, affecting nearly 4 million women in the U.S. alone. The condition potentially represents a significant financial burden to our nation's healthcare system. Researchers, with the support of grants from Cedars Sinai Health System and the National Institutes of Health, conducted a systematic review of published medical literature to identify studies that evaluated the epidemiology of PCOS, as well as its clinical consequences and related costs. Results, as published in the study "Healthcare-Related Economic Burden of the Polycystic Ovary Syndrome During the Reproductive Lifespan," revealed the total healthcare-related economic costs associated with the condition amount to a remarkable $4.36 billion. Specifically:

• Related costs stemming from PCOS-associated diabetes was found to be $1.77 billion (40.5 percent of total).
• The cost of hormonally treating menstrual dysfunction/abnormal uterine bleeding associated with PCOS was found to be $1.35 billion (31.0 percent of total).
• Treating hirsutism, a common symptom/side effect of PCOS, was found to be $622 million (14.2 percent of total).
• Providing infertility care for PCOS patients amounts to $533 million (12.2 percent of total).

The mean annual cost of the initial evaluation of PCOS was found to be just $93 million (2.1 percent of total costs), only a slight portion of the total economic burden associated with the condition. The true cost of PCOS may well exceed 4.5 billion since we did not consider the cost of treating the long-term morbidity of the disorder (e.g. type 2 DM) in the post-reproductive years. The researchers therefore concluded that more widespread and liberal screening for PCOS is the most cost-effective strategy to minimize the overall economic burden associated with this condition, as it would likely lead to earlier diagnosis and intervention.

Translating Research Into Practice:
Commentary on the PCOS study from The Endocrine Society's President Dr. Andrea Dunaif
"This article demonstrates for first time that there are substantial economic burdens associated with the polycystic ovary syndrome and should serve as a 'wake-up call' for the health care community. The study emphasizes the need to focus on early screening for and diagnosis of PCOS in order to treat the condition more effectively and cost efficiently as well as to prevent long term adverse health outcomes."

New Science from the Nurses' Health Study:
Level of Circulating Hormone Associated with Lower Cardiovascular Risk in Diabetic Women

Adiponectin is a hormone thought to play an important role in regulating factors associated with atherosclerosis such as glycemia (the presence of glucose in the blood), lipidemia (the presence of excess lipids in the blood), endothelial dysfunction and proinflammatory mechanisms. Low levels of circulating adiponectin are associated with obesity, as well as with hyperlipidemia and insulin resistance. In addition, low levels of adiponectin have been shown to be a predictor of type 2 diabetes and of cardiovascular events in diabetic patients. Previous studies, however, have not yet fully evaluated the potential associations between adiponectin levels and circulating inflammatory markers and/or lipoprotein abnormalities among diabetic women. Whether or not (and in what way) lifestyle factors, anthropometric measures (determinants of a patient's body shape and size), and glycemia play a role in this relationship is also unknown. In the context of the Nurses' Health Study (NHS) - a study that is among the largest prospective investigations into the risk factors for major chronic diseases in women - researchers examined potential associations between circulating adiponectin levels, blood lipid and lipoprotein levels, as well as several inflammatory markers in a study population of 925 diabetic women. The findings, as published in the study "Circulating Adiponectin Levels Are Associated with Better Glycemic Control, More Favorable Lipid Profile, and Reduced Inflammation in Women with Type 2 Diabetes," reveal that circulating adiponectin levels were significantly and positively associated with high-density lipoprotein (HDL, or "good") cholesterol and physical activity levels, and inversely associated with body mass index and plasma concentrations of markers that typically signify inflammation. Of particular note, with the exception of the associations with triglycerides and apolipoprotein B100 (a specific protein/lipid combination that is a constituent of LDL, or "bad" cholesterol), which were significant only in subjects with body mass index readings less than 30, all other associations observed in this study were the same among both obese and nonobese diabetic women. Overall, the researchers conclude that higher adiponectin levels are associated with better glycemic control, more favorable lipid profiles and reduced inflammation in diabetic women. Researchers encourage additional study into the ways in which lifestyle modifications and medications designed to increase adiponectin levels may improve cardiovascular risk profiles and decrease cardiovascular morbidity and mortality among women with type 2 diabetes.

You're Crashing Instead of Your Computer? Falling Asleep During the Day May Mean More about Your Overall Health Than You Think

It has been reported that excessive daytime sleepiness (EDS), the primary complaint of patients seen in sleep clinics, affects up to 12 percent of the general population and is commonly considered a sign of sleep apnea. Yet, the mechanism underlying the association between EDS and sleep apnea remains unclear. A team led by researchers at the Sleep Research and Treatment Center in the Department of Psychiatry at Penn State University College of Medicine assessed the association between the complaint of EDS and sleep apnea considering a wide range of possible risk factors in the study "Excessive Daytime Sleepiness in a General Population Sample: The Role of Sleep Apnea, Age, Obesity, Diabetes and Depression." The study population consisted of 16,583 men and women from Central Pennsylvania, ranging in age from 20 to 100 years. A random subset of this cohort (1,741 participants) was further evaluated for one night in a sleep laboratory setting. The study found that depression was the most significant risk factor associated with EDS, not sleep apnea. Further, a person's body mass index, age, typical sleep duration, the presence of diabetes and smoking habits all surpassed sleep apnea in strength of association with EDS. Interestingly, the older a person was, the less likely it was to see a relationship between their age and EDS, whereas the association of depression with EDS was stronger in the young. EDS was found to appear more often in trial participants younger than 30 years, suggesting the presence of unmet sleep needs and depression, and in participants older than 75 years, suggesting increasing medical illness and health problems. The researchers conclude that when diagnosing and treating a patient who complains of EDS, sleep apnea should not be the only cause considered. Rather, patients should be thoroughly assessed for depression, as well as obesity and diabetes, to rule out other causes that may impact one's sleepiness. After a full assessment of the patient's health, an appropriate treatment regimen can be implemented.