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Late menopause may increase type 2 diabetes risk
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Chinese women completing natural menopause at age 53 years or later have a 21% increased risk for developing type 2 diabetes vs. women completing menopause from age 45 to 52 years, according to findings from a cross-sectional study.
In an analysis of more than 17,000 postmenopausal women, the researchers also found that the relationship persisted after adjustment for multiple factors, including age, family history of diabetes, BMI and waist circumference, but was attenuated when adjusting for hypertension.
Meng Wang, MD, of the department of noncommunicable diseases control and prevention at the Zhejiang province Center for Disease Control and Prevention in Hangzhou, China, and colleagues analyzed data from naturally postmenopausal women participating in the China Kadoorie Biobank (CKB) study, conducted in Zhejiang province, between August 2004 and January 2008 (mean age, 49 years). Diabetes status was self-reported or identified by a random blood glucose level of at least 11.1 mmol/L or a fasting blood glucose of at least 7 mmol/L. Age at completion of menopause was also self-reported, and researchers stratified women into three groups by age at menopause: aged 44 years or younger, aged 45 to 52 years (reference group) or aged at least 53 years. Researchers used logistic regression analysis to measure the association between age at natural menopause and type 2 diabetes incidence.
Within the cohort, 1,288 (7.54%) women had type 2 diabetes, of which 712 were diagnosed by self-report and 576 were diagnosed based on glucose values.
Compared with women who completed menopause from age 46 to 52 years, women with natural menopause at age 53 years or older were 1.25 times more likely to have diabetes after adjustment for age, marital status, educational level, occupation, parity, smoking status and family history of diabetes, among other factors (95% CI, 1.06-1.47). However, after adding diagnosed hypertension to the model, the OR was attenuated (OR = 1.17; 95% CI, 0.99-1.39), according to researchers.
In subgroup analyses, researchers found that the association between later age at natural menopause and diabetes did not differ by BMI, smoking, physical activity and use of contraception. Results persisted after excluding women with cardiovascular disease and cancer.
“Although mechanisms accounting for the association between late menopause and increased diabetes risk among postmenopausal women are unclear, recent studies raised the possibility that the changes in hormone as well as body composition play an important role,” the researchers wrote. They noted that later age at menopause may lead to prolonged endogenous estrogen exposure, increasing the risk for impaired fasting glucose and diabetes, and that a recent CKB study found that later age at menopause was independently associated with increased adiposity, a risk marker for type 2 diabetes.
The researchers further noted that, in a similar study investigating the association between age at menopause and diabetes risk, the relationship was similarly attenuated after adjusting for hypertension and blood lipids.
“The findings, along with our results, suggest that when investigating the menopause-diabetes association in further study, metabolic factors should also be considered,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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