Assessment of Insulin Therapy as a Risk Factor for Hirsutism Among Diabetic Females in Saudi Arabia

Introduction Hirsutism is defined as a condition in which women develop excessive body hair in androgen-dependent areas, which include lips, chin, chest, abdomen, back, and femoral region. The link between hyperandrogenism and insulin resistance and/or hyperinsulinemia is well established. Polycystic ovary syndrome, as a form of hyperandrogenism, has been linked to several diseases, including type 2 diabetes mellitus and hirsutism. However, it is unknown how common hyperandrogenic problems are in women who receive exogenous insulin. Therefore, this study aims to assess the effect of insulin intake and other sociodemographic factors on the development of hirsutism among diabetic females. Methods This case-control study was conducted in six regions of Saudi Arabia, including Al-Ahsa, Dammam, Qatif, Riyadh, Abha, and Jeddah, during the year 2022. The population was Saudi females who were diabetic, between the age of 18 and 65 years, and living in Saudi Arabia. The sample size was 186 participants. Of the participants, 48 had considerable hirsutism whereas 138 did not. The degree of hirsutism has been determined using the Ferriman and Gallwey scoring tool. Results A total of 186 diabetic females were included in the study. Among the females, 97 (52.2%) were on insulin therapy and 89 (47.8%) were on non-insulin therapies. Only hair distribution on the chin showed a significant difference between the study groups where 4.1% of cases on insulin showed complete cover with light or heavy hair on the chin compared to 3.4% of controls (P = 0.049). There was no significant difference regarding hirsutism score among the study patients according to insulin intake where the mean score was 5.4 ± 5.1 among cases on insulin versus 4.7 ± 5.1 for controls (P = 0.978). Adjusted logistic regression models showed an insignificant association between diabetic female hirsutism and insulin intake (OR = 1.1 and 1.0, respectively; P > 0.05). Conclusion Many factors were examined to reveal their associations with hirsutism in diabetic females. Neither the type of diabetes nor insulin intake was significantly correlated with the development of hirsutism. On the other hand, age was found to be significantly associated with the development of hirsutism among age groups (<30, 30-49, and 50+; P = 0.49). It seemed that the prevalence of hirsutism decreases as age advances.