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Researchers find menopause does not raise risk for diabetes
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Menopause has little to no impact on the risk for diabetes, according to new data from the Diabetes Prevention Program.
In a first-of-a-kind study to assess the relationship between menopause and diabetes, researchers examined 1,237 women aged 40 to 65 years enrolled in the Diabetes Prevention Program who were at high risk for diabetes, including 708 premenopausal women; 328 who experienced natural menopause; and 201 who underwent bilateral oophorectomy. As part of the DPP, the study participants were randomly assigned to intensive lifestyle intervention, metformin or placebo.
Results indicated that the incidence of diabetes during the study was 11.8 cases per 100 person-years for the premenopausal group, 10.5 per 100 person-years for the natural menopause group and 12.9 per 100 person-years in those whose ovaries were removed. However, at 1.1 cases per 100 person-years, incidence was significantly lower for women who underwent bilateral oophorectomy in the lifestyle intervention arm (HR=0.19; 95% CI, 0.04-0.94). No differences were noted in the metformin group (HR=1.29; 95% CI, 0.63-2.64) or the placebo group (HR=1.37; 95% CI, 0.74-2.55).
“In our study, menopause had no additional effect on risk for diabetes,” Catherine Kim, MD, MPH, associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System, said in a press release. “Menopause is one of many small steps in aging and it doesn’t mean women’s health will be worse after going through this transition.”
Kim and colleagues pointed out that more research is required, especially regarding the role of hormone therapy and diabetes risk. Nevertheless, this information may reinforce the importance of diet and exercise to the prevention of diabetes and reassure women about the ramifications of menopause.
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Disclosure: Dr. Kim and colleagues report no relevant financial disclosures.
Risk for diabetes is associated with an increased risk for cardiovascular disease. It has been unclear whether menopause increases the risk for diabetes in women at high risk for the disease. This study evaluated the risk for developing diabetes and response to prevention interventions in women affected by menopause and hormone use in women identified to be at high risk for development of diabetes as determined by glucose intolerance. They followed 1,237 perimenopausal and menopausal women aged 40 to 65 years — 708 of whom were premenopausal; 328 of whom were naturally menopausal; and 201 who were surgically postmenopausal due to bilateral oophorectomy — for an average of 3.2 years.
The unadjusted diabetic case rate for the premenopausal group was 11.8 per 100 person-years in the placebo group, 6.6 per 100 person-years in the metformin group and 6.8 per 100 person-years in the lifestyle group. For postmenopausal women, the rate was 11.5 per 100 person-years in the placebo group, 8.9 per 100 person-years in the metformin group and 3.2 per 100 person-years in the lifestyle group. For naturally postmenopausal women, the diabetes case rate was 10.5 per 100 person-years in the placebo group, 5 per 100 person-years in the metformin group and 4.3 per 100 person-years in the lifestyle group compared with rates for surgically postmenopausal women of 12.9 per 100 person-years, 10.3 per 100 person-years and 1.1 per 100 person-years, respectively. No significant difference was found for hormone use in risk for diabetes in the overall population or by type of menopause, whether natural or surgical menopause. The significant difference found for the surgically menopausal group assigned to lifestyle intervention did not persist in those with hormone therapy. Thus, neither natural menopause nor surgical menopause (bilateral oophorectomy) was associated with an increased risk for diabetes compared with premenopausal women. Just as importantly, menopause did not affect response to diabetes prevention interventions. Surgical menopause was actually associated with a decreased risk of diabetes (HR=0.19) in the lifestyle intervention group; HT may modify this response.
For menopause specialists, this study shows that education about lifestyle changes of healthy eating and regular exercise can be effective in reducing the risk of diabetes in women at high risk for diabetes during menopause, regardless of type of menopause or use of HT. The study found that for every year 100 women were observed, 11.8 premenopausal women developed diabetes compared with 10.5 among women in natural menopause and 12.9 cases among women who had their ovaries removed.
Lifestyle recommendations are appropriate at all risk levels for CVD. At menopause, fluctuating hormone levels may be associated with blood glucose fluctuations, which may be compounded by weight gain and lack of exercise. Women with elevated glucose levels who have vaginal atrophy may be more likely to develop urinary or vaginal infections. Thus, patient visits to physicians are a perfect opportunity to discuss changes during perimenopause and early menopause to educate women about eating healthy, taking omega-3 fatty acids, exercising regularly, and improving blood sugar levels and symptoms due to fluctuating hormones. Decisions about the need for HT should be based on need for relief of menopausal symptoms. FDA-approved therapies such as transdermal estradiol paired with micronized progesterone may be particularly good choices for women at risk for diabetes.
– JoAnn V. Pinkerton, MD
Professor of
Obstetrics and Gynecology
Director, Midlife Health
University of
Virginia
Disclosure: Dr. Pinkerton reports no relevant financial disclosures.
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