Wednesday Bubble: diabetes and the ‘pause

Posted by on Jul 27, 2011 in diabetes, menopause | 0 comments

When I saw a post on my Facebook stream linking hormonal imbalance to diabetes, I become intrigued, ever more so when I ran across the following headline in my daily newsfeed:

“Does menopause matter when it comes to diabetes?”

So, does it or doesn’t it?

According to the first piece that resides on the website of the hormone franchise, BodyLogic MD, imbalances of  hormones other than insulin can promote insulin imbalances or resistance that is especially evident during menopause. Their hypothesis? Hormone replacement will correct these imbalances and prevent millions of women from developing diabetes.

In fact, there is evidence that as endogenous androgen levels rise and estrogen levels fall, there is a predisposition to glucose intolerance (i.e. a struggle to convert blood sugar or glucose into energy) and by default, diabetes. Moreover, estrogen therapy has been shown to reduce fasting blood glucose levels in menopausal women (fasting blood glucose or sugar measures glucose levels in the bloodstream and is a test for pre- and full blown diabetes). However, it is unknown if menopause itself is associated with high glucose levels or plays a role in influencing factors such as insulin secretion and insulin resistance that mediate glucose tolerance. Nevertheless, it is possible that menopause status may tip the scales in women who are already at high risk for diabetes or even influence activities undertaken to prevent the condition.

In a soon to be published study (August issue, Menopause journal), researchers compared perimenopausal women to women who had entered menopause naturally and those who had had their ovaries removed. All participants were between the ages of 45 and 58, and part of a larger Diabetes Prevention Program trial, meaning that they already had been diagnosed with having impaired glucose tolerance and fasting glucose levels and were at risk for diabetes. Of the 1,237 women studied, they had either been assigned twice daily diabetes medication (Metformin), twice-daily placebo tablet or an intensive lifestyle intervention to achieve and maintain a weight reduction of at least 7% (through a low-calorie, low-fat diet, and at least 150 minutes moderate physical activity weekly).

The results which also accounted for factors such as age, race/ethnicity, family history of diabetes, waist circumference and insulin resistance/response showed that for every 100 women observed, 11.8 premenopausal women developed diabetes, compared to 10.5 women in natural menopause and 12.9 in women with removed ovaries. Importantly, lifestyle changes appeared to impact these number: women who had undergone ovary removal and lost weight and exercised, only 1.1 for every 100 developed diabetes.

The conclusion? Natural menopause was not associated with an increased risk of diabetes even though the women in the study were already at high risk for diabetes. This implies that in women who not at risk, the likelihood of developing diabetes, would be even lower. However, the investigators say that a modest association cannot be completely ruled out.

What you need to know is that hormone mongers may tell you that you need to start taking hormones to prevent diabetes in menopause. The results of this well-designed scientific study suggests otherwise. And even suggest that lifestyle changes can solve this particular challenge.

As always, be cautious, ask questions and do your research. Menopause and diabetes? Nah, definitely not a definite; this one’s a reach.

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