Does PCOS with Dark Neck Mean Diabetes Later in Life?
Patient's Query
hi, I have diabetes, and I brought my daughter because she has irregular periods, a little unwanted hair on her chin, and darkening around her neck.
I searched online and found the word PCOS and also “acanthosis nigricans.” Now I am scared that she will get diabetes in future because our family already has diabetes. Some doctors even give metformin, which I know is a diabetes medicine, for PCOS.
How are PCOS and diabetes related? Is this dark neck a sign that she already has diabetes or prediabetes? If she loses weight and becomes fit, will her cycles become regular and will her future diabetes risk reduce? What tests should she do now?
Endocrinologist Answers
Your concern is valid, and the good news is that a lot can be improved with the right steps.
PCOS is strongly linked to insulin resistance. When insulin resistance is present, the body produces more insulin, and that can drive:
- Irregular cycles and ovulation problems.
- Higher androgen effects like chin hair.
- Dark, thick neck skin called Acanthosis Nigricans.
So an easy way to remember is: PCOS is often the ovary showing insulin resistance early. It does not mean she has diabetes today, but it does mean she has a higher future risk of prediabetes, type 2 diabetes, and gestational diabetes later in life compared to girls without PCOS.[1,5]
What helps the most is lifestyle.
Even a 5 to 10% weight loss can improve insulin resistance, help cycles become more regular, and reduce long-term diabetes risk. The 2023 international PCOS guideline puts lifestyle as first-line for almost everyone.[1,2]
Why metformin is used in PCOS
Metformin is not being used as a “diabetes treatment” here. It is used to reduce insulin resistance and improve metabolic outcomes, and it can help in some women with PCOS, especially if BMI is higher or sugars are drifting up. Dose is usually started low and increased gradually to reduce stomach side effects.[2,5]
What tests to do now
Ask your doctor about screening for:
- Fasting glucose and HbA1c
- Often a 75 g OGTT if risk is high or results are borderline
- Lipids and blood pressure. This is because PCOS is a metabolic condition, not only a cycle condition.[1,3]
Diabetes is not inevitable. Early action can change the path.
References:
- https://academic.oup.com/jcem/article/108/10/2447/7242360/
- https://www.monash.edu/__data/assets/pdf_file/0003/3371133/PCOS-Guideline-Summary-2023.pdf
- https://www.asrm.org/practice-guidance/practice-committee-documents/recommendations-from-the-2023-international-evidence-based-guideline-for-the-assessment-and-management-of-polycystic-ovary-syndrome/
- https://www.sciencedirect.com/science/article/pii/S0015028225019107
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10755126/
Disclaimer: The information provided in this Q&A is for educational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized medical guidance and treatment recommendations.