Type 1 diabetes and reproductive life

Women who have onset of type 1 diabetes (T1D) before menarche have a significantly shorter reproductive life compared to women who have never had diabetes, according to a study in the journal Menopause.

The women with T1D exhibited both delayed menarche and earlier natural menopause.

“Published research dating back to 2001 indicates that women with Type 1 diabetes have an earlier menopause,” said principal investigator Tina Costacou, PhD, an associate professor of epidemiology at the University of Pittsburgh in Pennsylvania. “Although the original study was well conducted, the sample size was small and, importantly, all study participants were relatively young at the time, so by definition, any women that would have reached menopause would have done so at a young age.”

Costacou became interested in validating the original study’s finding in a larger cohort of women with data available from young adulthood to a current age of at least 50.

The present study compared women with childhood-onset T1D who were diagnosed between 1950 and 1980 from the prospective Epidemiology of Diabetes Complications (EDC) study (n = 105) to nondiabetic women from the Pittsburgh site of the Study of Women's Health Across the Nation (SWAN) (n = 178).

Reproductive history was self-reported.

Women in the T1D cohort were younger, more likely to be White, never smokers, with lower body mass index (BMI) and higher high-density lipoprotein cholesterol levels (all P values < 0.05) vs. women without diabetes.

T1D women also were older at menarche (0.5 year delay, P = 0.002), but younger at natural menopause (-2.0 years, P < 0.0001). Thus, women with T1D experienced 2.5 fewer reproductive years compared to those without diabetes (P < 0.0001).

However, findings were statistically significant only in the subgroup of women who were diagnosed with T1D before reaching menarche (n = 80).

“I did not expect such a large gap in reproductive years between women with type 1 diabetes and women without diabetes, especially given more recent publications from Europe suggesting a similar age at menopause by type 1 diabetes status,” Costacou told Contemporary OB/GYN.

The study is unable to definitively identify the mechanism of action that causes a shorter reproductive period in women with T1D. “Because the shorter reproductive period was mainly observed in women diagnosed with type 1 diabetes prior to menarche, it could be hypothesized that worse beta cell function, and therefore inadequate insulin production and subsequent complete insulin deficiency in early childhood, might have affected the reproductive system more than when these events occur after menarche,” Costacou said.

From young adulthood, people with T1D have a greater burden of certain diseases like heart disease, according to Costacou. “Menopause increases the risk of heart disease, stroke and osteoporosis; hence, if women with type 1 diabetes reach menopause at a younger age, they should be carefully assessed for such conditions earlier than women in the general population,” she said.

A woman being aware that she may be at risk of having a shorter reproductive period “would allow her to prioritize childbearing, if she is interested in having children,” Costacou said.

Identifying potentially modifiable risk factors for a younger age at menopause in women with T1D also would be valuable.

“We are conducting further analyses to assess which factors predict an earlier age at menopause within the study’s type 1 diabetes cohort,” Costacou said.

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Costacou reports no relevant financial disclosures.

Reference

Yi Y, El Khoudary SR, Buchanich JM, et al. 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). Menopause. Published online March 1, 2021. doi:10.1097/GME.0000000000001758