Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review

Abstract

The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.

The Effects of Resistance Exercise Training on Skeletal Muscle Metabolism and Insulin Resistance Development in Female Rodents with Type 1 Diabetes

“…We did not observe a significant difference in serum estradiol between groups and did not observe a strong explanation of variance in IVGTT AUC by estradiol, which suggests that circulating estradiol in these animals did not significantly influence glucose tolerance. Previous work has suggested that a subset of the female population with T1DM exhibits fluctuations in insulin sensitivity through the menstrual cycle, while other female patients do not (97)(98)(99)(100). Our findings indicate a weak relationship between estradiol serum concentration and insulin sensitivity assessed by IVGTT in our female rodents with T1DM.…”

Case report: catamenial hyperglycemia: the trigger of recurrent DKA in a female patient with three-year follow-up

“…Women diagnosed with type 1 diabetes mellitus (T1DM) undergo fluctuations in their glycemic changeability due to variations in insulin receptor binding and affinity that are specifically linked to their menstrual cycle leading to Catamenial Hyperglycemia ( 10 – 12 ). Many studies has shown that compared to the early follicular phase, there is a higher likelihood of experiencing hyperglycemia during the periovulatory and early luteal phases.…”

Contributions to glucagon and pramlintide pharmacokinetics and pharmacodynamics modeling for multi-hormone artificial pancreas systems

“…Insulin sensitivity may also experiment variations in the same day due to stress, exercise, or food intake. Gender is another factor that may affect insulin sensitivity due to hormonal differences between men and women (Mauvais-Jarvis, 2018) Hence, advanced adaptive algorithms may be needed to deal effectively with sudden large changes in insulin sensitivity, such as during sickness or stress periods (El Youssef et al, 2011) and menstrual cycles (Gamarra and Trimboli, 2023;Trout et al, 2007).…”