ESPE Abstracts

Background: Type 1 diabetes (T1D), as one of the most common chronic autoimmune diseases, can have significant negative impact on pubertal development and overall reproductive health. Girls with T1D have been reported with delayed onset of menarche, in relation to premenarchal onset of T1D, inadequate metabolic control, insulin dosage, and duration of diabetes.

Methods: We conducted a retrospective cross-sectional single-center study on 108 girls (mean age 16.12±1.97 years), previously diagnosed with T1D (mean age at diagnosis 8.76±3.49 years), who achieved menarche at the time of the study. The data were collected from the medical records from February 2022 to February 2023.

Results: The average age of menarche in our study sample is 12.63±1.14 years. Of 108 patients, 93 (86.1%) were diagnosed with T1D prior to menarche (mean age 8.03 years, range 0.75-14.0 years). When stratified according to diabetes onset before (61/108) or after the age of 10 years, there was no significant difference in age of menarche. Girls with premenarchal T1D diagnosis have delayed menarchal age as compared to those with later T1D development (12.79 vs. 11.62 years), but the second subgroup sample was small. Among girls with premenarchal diabetes development, girls using insulin pumps had earlier menarche than those using multiple daily injections (12.51 vs. 13.02 years, t(91)= 2.427, P = 0.009). Diabetic ketoacidosis (DKA) at diagnosis was found in 30/93 patients; this subgroup has earlier age of menarche (12.28 vs. 13.03 years, t(88) = -3.358, P < 0.01). There was no significant correlation between age of menarche and duration of diabetes, HbA1c level at menarche, and 1^st and 2^nd year before (average HbA1c at menarche 7.78%±1.03), total daily insulin dose, autoimmune thyroid disease and DKA during follow up.

Conclusion: Contrary to earlier reports, we did not confirm the influence of T1D onset before age of 10 years on later age of menarche. Among girls with premenarchal T1D development, factors such as metabolic control, duration of diabetes or insulin dosage did not yield significant effects in our study group, but we found earlier menarchal age in girls using insulin pump therapy and those with DKA at diagnosis. Our findings might suggest later age of menarche in girls with premenarchal T1D onset, but more studies in larger samples are necessary. Further research to identify T1D risk factors that can influence reproductive health may improve care for children and adolescents with diabetes.