{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:59:59Z","timestamp":1790373599185,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp; Metabol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Women with polycystic ovary syndrome (PCOS) are more susceptible to metabolic dysfunction, especially glucose impairment. Previous studies have considered prediabetes (pre\u2010DM) and diabetes mellitus (DM) as single\u2010point outcomes without accounting for the transition states. This study aimed to explore the transition between different blood glucose states using a multistate Markov model among women with and without PCOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study employed a dataset from the population\u2010based study of the Tehran Lipid and Glucose Study. Women, aged over 20\u2009years, without pre\u2010DM and DM at baseline (1999\u20132000) and with documented PCOS status, were included; subsequent follow\u2010ups were conducted every 3\u2009years, totaling six follow\u2010up assessments. Three states of \u2018Normoglycemia\u2019, \u2018Pre\u2010DM\u2019, and \u2018DM\u2019 and three possible transitions of (I) normoglycemia to pre\u2010DM, (II) normoglycemia to DM, and (III) pre\u2010DM to DM were defined. The multi\u2010state Markov models were applied to examine the predictive effect of PCOS on the transition rates throughout the progression of DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 1587 participated women, 782 (49.3%) remained free of pre\u2010DM and DM at the end of the study. Transition from normoglycemia to pre\u2010DM was the most frequent progression observed, affecting 46.6% of the study participants. Women with PCOS significantly had 23% higher hazard of transition I [HR (95% CI): 1.23 (1.01\u20131.49);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034] compared to those without PCOS. While being PCOS did not significantly affect the risk of other transitions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study underscores the significant impact of PCOS on the dynamic progression from normoglycemia to pre\u2010DM. Future longitudinal studies are essential to support our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70322","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:31:16Z","timestamp":1787859076000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of Polycystic Ovarian Syndrome on Development of Diabetes Mellitus by a Multistate Modelling Approach"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3946-2507","authenticated-orcid":false,"given":"Maryam","family":"Mousavi","sequence":"first","affiliation":[{"name":"Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1259-2459","authenticated-orcid":false,"given":"Marzieh","family":"Saei Ghare Naz","sequence":"additional","affiliation":[{"name":"Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahsa","family":"Noroozzadeh","sequence":"additional","affiliation":[{"name":"Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6470-2517","authenticated-orcid":false,"given":"Fereidoun","family":"Azizi","sequence":"additional","affiliation":[{"name":"Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4621-7972","authenticated-orcid":false,"given":"Fahimeh","family":"Ramezani Tehrani","sequence":"additional","affiliation":[{"name":"Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran"},{"name":"Foundation for Research &amp; Education Excellence  Vestavia Hills Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/jhrs.JHRS_95_18"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S70314"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2019.08.010"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05746-x"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-S062"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-001529"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(25)00237-2"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1669716"},{"issue":"6","key":"e_1_2_13_10_1","article-title":"Prospective Risk of Type 2 Diabetes in Normal Weight Women With Polycystic Ovary Syndrome","volume":"10","author":"Glintborg D.","year":"2022","journal-title":"Biomedicine"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2017.09.004"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-12-7"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112349"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_1695_17"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110640"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24043140"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14124021"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.2217\/WHE.11.94"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v13.i3.240"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40471-022-00291-y"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.30002"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-10-5"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s000380200008"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.5812\/ijem-167151"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh098"},{"issue":"5","key":"e_1_2_13_27_1","first-page":"279","article-title":"Reliability and Validity of the Modifiable Activity Questionnaire (MAQ) in an Iranian Urban Adult Population","volume":"15","author":"Momenan A. 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