With the rate of diabetes and prediabetes/glucose intolerance increasing, it is imperative for clinicians to help reduce the risk of their patients developing full-blown diabetes as well as to help patients manage the illness.
With the rate of diabetes and prediabetes/glucose intolerance increasing, it is imperative for clinicians to help reduce the risk of their patients developing full-blown diabetes as well as to help patients manage the illness. Recent research has pointed to a possible link between menopause and the rapid progression of glucose intolerance, possibly because of the change of hormone levels. For instance, data have shown that high levels of testosterone in women are a risk factor for diabetes. In hopes to better understand this possible link and thus create improved treatment strategies, Dr Catherine Kim, assistant professor in the departments of internal medicine and obstetrics and gynecology at the University of Michigan, and colleagues sought to determine if menopause status is indeed a risk factor for developing diabetes, especially among women who are already at high risk for developing the disease. They further sought to determine if menopause affects response to diabetes prevention interventions. Their study is the first longitudinal report of its kind.
To complete this analysis, Kim and colleagues leveraged data from the Diabetes Prevention Program, a randomized study looking at prevention interventions for adults with impaired fasting glucose and glucose intolerance. Participants who were at least 25 years were randomized to metformin twice daily (850 mcg), placebo twice daily, or a lifestyle intervention. For this study, data were analyzed from women who were between 40 and 64 years; they excluded women who reported irregular menses, those who were on hormonal treatment while menstruating, and those who reported menses up to the time of hysterectomy. This left a sample of premenopausal women (n = 708) and postmenopausal women (n = 529).
During the Diabetes Prevention Program study, women were tested annually via oral glucose tolerance tests and semiannually for fasting plasma glucose levels. Total circulating adiponectin was measured at baseline and 1 year after randomization. Kim and colleagues compared age and baseline-adjusted weight, waist circumference, insulin resistance, corrected insulin response, and glucose levels as well as biomarkers (eg, adiponectin, C-reactive protein, fibrinogen, and tissue plasminogen activator antigen) by menopause status to determine if menopause status affected intervention outcomes. The unadjusted cumulative incidences of diabetes for the groups can be found in the Figure.
Figure. Unadjusted cumulative incidences of diabetes in cases per 100 person-years.
Based on the results, no association was found between natural menopause and an increased risk of diabetes. This finding remained even after adjusting for race/ethnicity, family history of diabetes, hormone therapy use, and other clinical and demographic factors. The researchers further found that bilateral oophorectomy was associated with a decreased risk of diabetes for women in the lifestyle intervention only; however, the researchers could not determine if this effect was independent of any effects from hormone treatment. Finally, in examining the impact of menopause status on diabetes interventions, there were no significant differences in changes in weight waist circumference, fasting plasma glucose levels, and other study indicators.
“The present report has clinical and public health relevance, showing that natural menopause does not modify the impact of diabetes prevention interventions among women at high risk for diabetes,” Kim and colleagues explained. “Although we did not find a significant association between natural menopause and diabetes risk, our study cannot completely rule out a more modest association.”
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Kim C, Edelstein SL, Crandall JP, et al.Menopause and risk of diabetes in the Diabetes Prevention Program. Menopause. 201;18(8):857-868.