Women with Type 1 diabetes (T1D) experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women's Health Across the Nation (SWAN)

Yi, Yan; Khoudary, Samar R. El; Buchanich, Jeanine M.; Miller, Rachel G.; Rubinstein, Debra; Matthews, Karen A.; Orchard, Trevor J.; Costacou, Tina

doi:10.1097/gme.0000000000001758

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…In a prospective study, women who developed type 1 DM before menarche were found to have delayed menarche and earlier age of menopause. 5 Similarly, in a cross-sectional study of women with SLE, age of natural menopause was significantly younger among patient with SLE (47 years) when compared with healthy individuals (50.5 years). 6 We contend that IBD has similar immune mechanisms that lead to chronic inflammation and earlier onset of menopause.…”

Section: Discussionmentioning

confidence: 92%

A Cohort Study of the Age at Menopause in Female Patients With and Without Inflammatory Bowel Disease

Moktan

Daoud

Loftus

et al. 2022

Crohn's &Amp; Colitis 360

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Introduction Menopause, defined by the complete cessation of menstrual cycles for 12 consecutive months, may occur at a younger age in women who have concomitant immune dysregulation. Our aim was to determine whether women with inflammatory bowel disease (IBD) experience an earlier onset of menopause compared to women without IBD. Methods This was a retrospective cohort study using resources of the Rochester Epidemiology Project, a collaboration between clinics, hospitals and medical facilities in Olmsted County, Minnesota. From these people, women who were diagnosed with IBD between 1970 and 2010 comprised the case cohort while the reference cohort included women with no diagnosis of IBD. Data including age, body mass index (BMI), ethnicity, smoking status, age at onset of menopause and current use of hormone therapy was collected. Patients with history of hysterectomy or oophorectomy were excluded. Wilcoxon rank-sum test for numeric variables and Fisher’s exact test for categorical variables was used to analyze the data. Results A total of 171 women met criteria for inclusion (83 cases and 88 controls). Mean age of menopause in women with IBD was 50.0 years compared to 51.5 years in women with no IBD (p=.006). There was no difference in BMI of women with and without IBD (28.7 kg/m 2 versus 28.2 kg/m 2; p=0.9), respectively. There were more former smokers (33.7%) and current (6%) smokers in the IBD group (p=0.009) compared to the non-IBD group. Conclusions IBD is associated with an earlier onset of menopause. Although it is unclear if this mean difference of 1.5 years is clinically relevant, it is known that early menopause is associated with an increased risk of osteoporosis and cardiovascular disease. Further research on the possible mechanisms is needed.

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Section: Discussionmentioning

confidence: 92%

A Cohort Study of the Age at Menopause in Female Patients With and Without Inflammatory Bowel Disease

Moktan

Daoud

Loftus

et al. 2022

Crohn's &Amp; Colitis 360

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“…[69][70][71][72] Following childbearing, the hormonal shifts of perimenopause and menopause combined with common life stressors of middle age and gendered parenting roles may explain somewhat higher HbA1c values among many middle-aged female people. As noted by the lead patient partner in this project (DG), the evidence available about menopause and type 1 diabetes is scarce, with a few studies about age of menopause [73][74][75][76] and associated health risks [77], but very little evidence about how to manage one's diabetes and other health concerns post-menopause. [78] This evidence gap impacts negatively on the lives of people with the condition who progress through menopause.…”

Section: Interpretation Of Results By Team Members With Diabetesmentioning

confidence: 99%

The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People with Type 1 and Type 2 Diabetes in Canada: A Patient-Led Longitudinal Retrospective Cohort Study

Mousavi

Greenberg

Ndjaboué

et al. 2021

Preprint

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BackgroundClinical guidelines for most adults with diabetes recommend maintaining hemoglobin A1c (HbA1c) ≤7.0% (<53 mmol/mol) to avoid microvascular and macrovascular complications. People with diabetes of different ages, sexes, and socioeconomic statuses may differ in their ease of attaining this goal. As a team of people with diabetes, researchers, and health professionals, we aimed to explore patterns in HbA1c results among people with type 1 or type 2 diabetes in Canada. Our research question was identified by people living with diabetes.MethodsWe used generalized estimating equations to analyze the effects of age, sex and socioeconomic status in 947,543 HbA1c results measured from 2010 to 2019 among 90,770 people living with type 1 or 2 diabetes in Canada. People living with diabetes reviewed and interpreted the results.ResultsHbA1c results at or below 7.0% represented 30.5% (male people living with type 1 diabetes), 21.0% (female people living with type 1 diabetes), 55.0% (male people living with type 2 diabetes) and 59.0% (female people living with type 2 diabetes) of results in each subcategory. We observed higher HbA1c values during adolescence and, for people living with type 2 diabetes, among people living in lower income areas. Among those with type 1 diabetes, female people tended to have lower HbA1c than male people during childbearing years but higher HbA1c than male people during menopausal years. Team members living with diabetes confirmed that the patterns we observed reflected their own life courses and suggested these results be communicated to health professionals and other stakeholders to improve treatment for people living with diabetes.InterpretationA substantial proportion of people with diabetes in Canada are insufficiently supported to maintain guideline-recommended glycemic control goals. Blood sugar management goals may be particularly challenging for people who are going through adolescence, menopause, or living with fewer financial resources. Health professionals should be aware of the challenging nature of glycemic management and policymakers in Canada should provide more support for people with diabetes to live healthy lives.

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“…The European Prospective Investigation into Cancer and Nutrition (EPIC) study also suggested that early-onset diabetes (onset before the age of 20 y) was associated with an earlier onset of menopause, compared with nondiabetic controls 12 . In our recent study, we noted that natural menopause occurred 2.0 years earlier in women with childhood-onset type 1 diabetes compared with non-diabetic women after adjustment for age at baseline, age at menarche, race, BMI, smoking status, blood pressure, HDL, and non-HDL cholesterol, number of pregnancies, and having ever taken oral contraceptives 13 …”

mentioning

confidence: 77%

Predictors of the age at which natural menopause occurs in women with type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study

Khoudary

Buchanich

et al. 2021

Menopause

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Objective: Women with type 1 diabetes (T1D) are thought to experience menopause earlier than women without diabetes, although not all studies agree. We assessed metabolic predictors of the age at which natural menopause occurs among women with T1D participating in the Epidemiology of Diabetes Complications study. Methods: Women with childhood-onset (<17 y) of T1D who underwent natural menopause without use of hormone therapy during their menopausal transition were included in the analysis (n = 105; mean baseline age, 29.5 and diabetes duration, 20.2 y). Self-reported reproductive history and the Women's Ischemia Syndrome Evaluation hormonal algorithms were used to determine menopause status. Linear regression was used to ascertain whether time-weighted metabolic factors (eg, BMI, lipids, HbA1c, insulin dose, albumin excretion rate [AER]) were associated with age at natural menopause. Results: Univariately, only insulin dose (β = −4.87, P = 0.04) and log (AER) (β = −0.62, P = 0.02) were associated (negatively) with age at natural menopause. Adjusting for BMI, smoking status, lipids, HbA1c, number of pregnancies, and oral contraceptive use, each 0.1 unit increase in the daily dose of insulin per kilogram body weight was associated with 0.64 years younger age at natural menopause (P = 0.01), while for every 30% increase in AER, age at natural menopause decreased by 0.18 years (P = 0.03). Conclusion: Higher average levels of insulin dose and AER over time were significantly associated with a younger age at which natural menopause occurred among women with T1D. The biologic mechanisms underlying the observed associations between exogenous insulin dose and AER on reproductive health should be investigated among women with T1D.

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Women with Type 1 diabetes (T1D) experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women's Health Across the Nation (SWAN)

Cited by 16 publications

References 42 publications

A Cohort Study of the Age at Menopause in Female Patients With and Without Inflammatory Bowel Disease

A Cohort Study of the Age at Menopause in Female Patients With and Without Inflammatory Bowel Disease

The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People with Type 1 and Type 2 Diabetes in Canada: A Patient-Led Longitudinal Retrospective Cohort Study

Predictors of the age at which natural menopause occurs in women with type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study

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