Background and aim: Epidemiologic observations suggest that women with type 1 diabetes mellitus (T1DM) often suffer from menstrual cycle disorders. There may also be a negative association between the age of onset of T1DM and the age of menarche. Delayed menarche, in turn, may be associated with increased risk for diabetic complications. The aim of this study was to prospectively investigate pathologic manifestations of reproductive function in young women with T1DM and their possible association with stress, glycemic, metabolic, autoimmune or family history parameters.
Patiants and methods: We studied 53 women with T1DM 19.4±4.3 years old with T1DM duration of 8.0±5.6 years. Anthropometric measurements, age and clinical presentation at diagnosis, insulin regimen, glycemic control and hypoglycemic episodes, diabetic complications and other autoimmune diseases were recorded. Information regarding reproductive function included age of menarche, duration of menstrual cycle and manifestations of hyperandrogenism, hirsutism or acne.
Results: Diagnosis of T1DM was made at 11.5±4.7 years, with 17% (9/53) of patients presenting with ketoacidosis. Among patients, 83% (44/53) were on multiple daily insulin injections and the rest on insulin pump therapy (9/53, 17%), with total insulin requirements 0.7±0.22 u/kg. The last HbA1c measurement was 8.4±1.8%, with 7.3±7.9 hypoglycemic episodes per month. Most patients had normal BMI (22.2±2.7 kg/m2). Only one (1.9%) presented diabetic retinopathy, while three (5.7%) had albuminuria. Autoimmune thyroiditis was present in 22.6% (12/53), whereas two additional patients suffered from other autoimmune diseases (26.4%). Two women (3.8%) had not experienced menarche at the age of 15.5 and 16.6 years, while the mean age of menarche for the rest women was 12.7±1.3 y (slightly higher than the reported average age of menarche of 12.29 y in normal weight Greek girls). The patients who had menarche were studied 7.3±4.7 years after, with 23.5% (12/51) having oligomenorrhea (menstrual cycle duration >35 days). Only 13.2% (7/53) reported positive family history for menstrual disturbances. A high proportion (32.1%, 17/53) had hirsutism, while 45.3% (24/53) had acne, both signs of hyperandrogenism.
Conclusions: Young women with T1DM present increased frequency of menstrual disturbances and signs of hyperandrogenism compared with those reported in non-diabetic Greek females. These findings may be the result of hypercortisolism and hyperandrogenism due to chronic hyperactivation of the hypothalamic-pituitary-adrenal axis, while the effects of glycemic regulation, hyperinsulinemia, complications or autoimmunity should be also further clarified.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology