Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus

Abstract

Background: Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. Methods: This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. Results: During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30−34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35−39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. Conclusion: Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.

Association of uterine leiomyoma with type 2 diabetes mellitus in young women: a population-based cohort study

“…4 Considering the hormonal changes in obese women or women with metabolic syndrome, it is likely that rather than UL itself, the uterus, endometrium, and ovaries might affect the development of type 2 diabetes mellitus. [17][18][19][20] A retrospective population-based cohort study found that the risk of diabetes was higher in women with hysterectomy compared to that in those without hysterectomy (HR 1.37, 95%CI 1.23-1.52) and that diabetes risk was not increased in women with hysterectomy and oophorectomy (HR: 1.28, 95%CI 0.93-1.76). 21 Interestingly, myomectomy seemed to attenuate the risk for type 2 diabetes mellitus in women with UL in our study.…”

Reproductive Lifespan and Motor Progression of Parkinson’s Disease

“…The reproductive lifespan represents not only the years during which women can conceive but also the period in which women benefit from estrogen exposure [ 11 ]. The reproductive lifespan has been related to decreased morbidity, decreased mortality, and cardioprotection [ 25 , 26 ].…”

“…The reproductive lifespan is the time period between menarche and menopause, which can reflect the period in which a woman benefits from estrogen exposure [ 11 ]. To date, some cross-sectional studies have explored the association between the reproductive lifespan and the clinical features of PD.…”

Menopause and development of Alzheimer’s disease: Roles of neural glucose metabolism and Wnt signaling

“…muscular and brain tissue. E 2 also controls the metabolic sensor in the hypothalamus, protecting the brain from hypoglycemia ( 60 ). Otherwise, E 2 potentiates the oxidative capacity of mitochondria and E 2 deprivation induces mitochondrial dysfunction and insulin resistance, mechanisms involved in the development of alterations in cognitive function ( 61 ).…”