1
|
Paschou SA, Athanasiadou KI, Papanas N. Menopausal Hormone Therapy in Women with Type 2 Diabetes Mellitus: An Updated Review. Diabetes Ther 2024; 15:741-748. [PMID: 38363540 PMCID: PMC10951155 DOI: 10.1007/s13300-024-01546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.
Collapse
Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Medical School, University Hospital of Alexandroupolis, Democritus University of Thrace, G. Kondyli 22, 68132, Alexandroupolis, Greece.
| |
Collapse
|
2
|
Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients 2023; 16:27. [PMID: 38201856 PMCID: PMC10780928 DOI: 10.3390/nu16010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.
Collapse
Affiliation(s)
- Aliz Erdélyi
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
| | - Erzsébet Pálfi
- Faculty of Health Sciences, Department of Dietetics and Nutritional Sciences, Semmelweis University, 1088 Budapest, Hungary
| | - László Tűű
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Katalin Nas
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Zsuzsanna Szűcs
- Hungarian Dietetic Association, 1034 Budapest, Hungary; (A.E.); (Z.S.)
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Marianna Török
- EndoCare Institute, Endocrinology Center, 1037 Budapest, Hungary; (L.T.); (K.N.)
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary;
- Department of Obstetrics and Gynecology, University of Szeged, 6725 Szeged, Hungary
| |
Collapse
|
3
|
Vigil P, Meléndez J, Petkovic G, Del Río JP. The importance of estradiol for body weight regulation in women. Front Endocrinol (Lausanne) 2022; 13:951186. [PMID: 36419765 PMCID: PMC9677105 DOI: 10.3389/fendo.2022.951186] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Obesity in women of reproductive age has a number of adverse metabolic effects, including Type II Diabetes (T2D), dyslipidemia, and cardiovascular disease. It is associated with increased menstrual irregularity, ovulatory dysfunction, development of insulin resistance and infertility. In women, estradiol is not only critical for reproductive function, but they also control food intake and energy expenditure. Food intake is known to change during the menstrual cycle in humans. This change in food intake is largely mediated by estradiol, which acts directly upon anorexigenic and orexigenic neurons, largely in the hypothalamus. Estradiol also acts indirectly with peripheral mediators such as glucagon like peptide-1 (GLP-1). Like estradiol, GLP-1 acts on receptors at the hypothalamus. This review describes the physiological and pathophysiological mechanisms governing the actions of estradiol during the menstrual cycle on food intake and energy expenditure and how estradiol acts with other weight-controlling molecules such as GLP-1. GLP-1 analogs have proven to be effective both to manage obesity and T2D in women. This review also highlights the relationship between steroid hormones and women's mental health. It explains how a decline or imbalance in estradiol levels affects insulin sensitivity in the brain. This can cause cerebral insulin resistance, which contributes to the development of conditions such as Parkinson's or Alzheimer's disease. The proper use of both estradiol and GLP-1 analogs can help to manage obesity and preserve an optimal mental health in women by reducing the mechanisms that trigger neurodegenerative disorders.
Collapse
Affiliation(s)
- Pilar Vigil
- Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Jaime Meléndez
- Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Grace Petkovic
- Arrowe Park Hospital, Department of Paediatrics, Wirral CH49 5PE, Merseyside, United Kingdom
| | - Juan Pablo Del Río
- Unidad de Psiquiatría Infantil y del Adolescente, Clínica Psiquiátrica Universitaria, Universidad de Chile, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Millennium Science Initiative, Santiago, Chile
| |
Collapse
|
4
|
Lambrinoudaki I, Paschou SA, Armeni E, Goulis DG. The interplay between diabetes mellitus and menopause: clinical implications. Nat Rev Endocrinol 2022; 18:608-622. [PMID: 35798847 DOI: 10.1038/s41574-022-00708-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/27/2022]
Abstract
The menopausal transition is an impactful period in women's lives, when the risk of cardiovascular disease is accelerated. Similarly, diabetes mellitus profoundly impacts cardiovascular risk. However, the interplay between menopause and diabetes mellitus has not been adequately studied. The menopausal transition is accompanied by metabolic changes that predispose to diabetes mellitus, particularly type 2 diabetes mellitus (T2DM), as menopause results in increased risk of upper body adipose tissue accumulation and increased incidence of insulin resistance. Equally, diabetes mellitus can affect ovarian ageing, potentially causing women with type 1 diabetes mellitus and early-onset T2DM to experience menopause earlier than women without diabetes mellitus. Earlier age at menopause has been associated with a higher risk of T2DM later in life. Menopausal hormone therapy can reduce the risk of T2DM and improve glycaemic control in women with pre-existing diabetes mellitus; however, there is not enough evidence to support the administration of menopausal hormone therapy for diabetes mellitus prevention or control. This Review critically appraises studies published within the past few years on the interaction between diabetes mellitus and menopause and addresses all clinically relevant issues, such as the effect of menopause on the development of T2DM, and the management of both menopause and diabetes mellitus.
Collapse
Affiliation(s)
- Irene Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.
| | - Stavroula A Paschou
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Armeni
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
5
|
Sokolowska P, Jastrzebska E, Dobrzyn A, Brzozka Z. Investigation of the Therapeutic Potential of New Antidiabetic Compounds Using Islet-on-a-Chip Microfluidic Model. BIOSENSORS 2022; 12:bios12050302. [PMID: 35624603 PMCID: PMC9138207 DOI: 10.3390/bios12050302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
Nowadays, diabetes mellitus is one of the most common chronic diseases in the world. Current research on the treatment of diabetes combines many fields of science, such as biotechnology, transplantology or engineering. Therefore, it is necessary to develop new therapeutic strategies and preventive methods. A newly discovered class of lipids—Palmitic Acid Hydroxy Stearic Acid (PAHSA) has recently been proposed as an agent with potential therapeutic properties. In this research, we used an islet-on-a-chip microfluidic 3D model of pancreatic islets (pseudoislets) to study two isomers of PAHSA: 5-PAHSA and 9-PAHSA as potential regulators of proliferation, viability, insulin and glucagon expression, and glucose-stimulated insulin and glucagon secretion. Due to the use of the Lab-on-a-chip systems and flow conditions, we were able to reflect conditions similar to in vivo. In addition, we significantly shortened the time of pseudoislet production, and we were able to carry out cell culture, microscopic analysis and measurements using a multi-well plate reader at the same time on one device. In this report we showed that under microfluidic conditions PAHSA, especially 5-PAHSA, has a positive effect on pseudoislet proliferation, increase in cell number and mass, and glucose-stimulated insulin secretion, which may qualify it as a compound with potential therapeutic properties.
Collapse
Affiliation(s)
- Patrycja Sokolowska
- Chair of Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, 00-661 Warsaw, Poland; (E.J.); (Z.B.)
- Laboratory of Cell Signaling and Metabolic Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland;
- Correspondence:
| | - Elzbieta Jastrzebska
- Chair of Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, 00-661 Warsaw, Poland; (E.J.); (Z.B.)
| | - Agnieszka Dobrzyn
- Laboratory of Cell Signaling and Metabolic Disorders, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland;
| | - Zbigniew Brzozka
- Chair of Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, 00-661 Warsaw, Poland; (E.J.); (Z.B.)
| |
Collapse
|
6
|
Maximizing the Estrogenic Potential of Soy Isoflavones through the Gut Microbiome: Implication for Cardiometabolic Health in Postmenopausal Women. Nutrients 2022; 14:nu14030553. [PMID: 35276910 PMCID: PMC8840243 DOI: 10.3390/nu14030553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Soy isoflavones have been suggested as an alternative treatment for managing postmenopausal symptoms and promoting long-term health due to their structural similarity to mammalian estrogen and ability to bind to estrogen receptors. Among all soy isoflavones and their metabolites, (S)-equol is known for having the strongest estrogenic activity. Equol is a metabolite of the soy isoflavone daidzein produced through intestinal bacterial metabolism. However, more than half of the human population is not able to produce equol due to the lack of equol-producing bacteria in their gastrointestinal tract. The interpersonal variations in the gut microbiome complicate the interpretation of data collected from humans. Furthermore, because rodents are efficient equol-producers, translatability between rodent models and humans is challenging. Herein, we first summarized the current knowledge of the microbial conversion of daidzein to equol, its relation to health, and proposed the need for developing model systems by which equol production can be manipulated while controlling other known confounding factors. Determining the necessity of equol-producing capacity within a gut microbial community when consuming soy as a functional ingredient, and identifying strategies to maximize equol production by modulating the gut microbiome, may provide future therapeutic approaches to improve the health of postmenopausal women.
Collapse
|
7
|
Campesi I, Seghieri G, Franconi F. Type 2 diabetic women are not small type 2 diabetic men: Sex-and-gender differences in antidiabetic drugs. Curr Opin Pharmacol 2021; 60:40-45. [PMID: 34325380 DOI: 10.1016/j.coph.2021.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
Many pieces of evidence have accumulated over time suggesting sex-and-gender differences in type 2 diabetes, the most relevant being the greater excess risk of cardiovascular diseases in women with diabetes than in men. Drugs available for the treatment of diabetes have, meanwhile, increased in number and effectiveness over the last 20 years. Nonetheless, overall metabolic control of diabetes continues to be suboptimal, with a clear further disadvantage for women. Moreover, old and new glucose-lowering drugs present some sex-and-gender differences, although women continue to be underrepresented in all cardiovascular outcome trials testing their efficacy and protective effects. We conclude that pharmacology should wear gender glasses starting from preclinical research to overcome all these gender gaps.
Collapse
Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100, Sassari, Italy; Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy.
| | | | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy
| |
Collapse
|
8
|
Estrogen and Glycemic Homeostasis: The Fundamental Role of Nuclear Estrogen Receptors ESR1/ESR2 in Glucose Transporter GLUT4 Regulation. Cells 2021; 10:cells10010099. [PMID: 33430527 PMCID: PMC7827878 DOI: 10.3390/cells10010099] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Impaired circulating estrogen levels have been related to impaired glycemic homeostasis and diabetes mellitus (DM), both in females and males. However, for the last twenty years, the relationship between estrogen, glycemic homeostasis and the mechanisms involved has remained unclear. The characterization of estrogen receptors 1 and 2 (ESR1 and ESR2) and of insulin-sensitive glucose transporter type 4 (GLUT4) finally offered a great opportunity to shed some light on estrogen regulation of glycemic homeostasis. In this manuscript, we review the relationship between estrogen and DM, focusing on glycemic homeostasis, estrogen, ESR1/ESR2 and GLUT4. We review glycemic homeostasis and GLUT4 expression (muscle and adipose tissues) in Esr1−/− and Esr2−/− transgenic mice. We specifically address estradiol-induced and ESR1/ESR2-mediated regulation of the solute carrier family 2 member 4 (Slc2a4) gene, examining ESR1/ESR2-mediated genomic mechanisms that regulate Slc2a4 transcription, especially those occurring in cooperation with other transcription factors. In addition, we address the estradiol-induced translocation of ESR1 and GLUT4 to the plasma membrane. Studies make it clear that ESR1-mediated effects are beneficial, whereas ESR2-mediated effects are detrimental to glycemic homeostasis. Thus, imbalance of the ESR1/ESR2 ratio may have important consequences in metabolism, highlighting that ESR2 hyperactivity assumes a diabetogenic role.
Collapse
|
9
|
Onset of the climacteric phase by the mid-forties associated with impaired insulin sensitivity: a birth cohort study. ACTA ACUST UNITED AC 2021; 28:70-79. [DOI: 10.1097/gme.0000000000001658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
10
|
Lee J, Walter MF, Korach KS, Noguchi CT. Erythropoietin reduces fat mass in female mice lacking estrogen receptor alpha. Mol Metab 2020; 45:101142. [PMID: 33309599 PMCID: PMC7809438 DOI: 10.1016/j.molmet.2020.101142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Erythropoietin (EPO), the cytokine required for erythropoiesis, contributes to metabolic regulation of fat mass and glycemic control. EPO treatment in mice on high-fat diets (HFD) improved glucose tolerance and decreased body weight gain via reduced fat mass in males and ovariectomized females. The decreased fat accumulation with EPO treatment during HFD in ovariectomized females was abrogated with estradiol supplementation, providing evidence for estrogen-related gender-specific EPO action in metabolic regulation. In this study, we examined the cross-talk between estrogen mediated through estrogen receptor α (ERα) and EPO for the regulation of glucose metabolism and fat mass accumulation. Methods Wild-type (WT) mice and mouse models with ERα knockout (ERα−/−) and targeted deletion of ERα in adipose tissue (ERαadipoKO) were used to examine EPO treatment during high-fat diet feeding and after diet-induced obesity. Results ERα−/− mice on HFD exhibited increased fat mass and glucose intolerance. EPO treatment on HFD reduced fat accumulation in male WT and ERα−/− mice and female ERα−/− mice but not female WT mice. EPO reduced HFD increase in adipocyte size in WT mice but not in mice with deletion of ERα independent of EPO-stimulated reduction in fat mass. EPO treatment also improved glucose and insulin tolerance significantly greater in female ERα−/− mice and female ERαadipoKO compared with WT controls. Increased metabolic activity by EPO was associated with browning of white adipocytes as shown by reductions in white fat-associated genes and induction of brown fat-specific uncoupling protein 1 (UCP1). Conclusions This study clearly identified the role of estrogen signaling in modifying EPO regulation of glucose metabolism and the sex-differential EPO effect on fat mass regulation. Cross-talk between EPO and estrogen was implicated for metabolic homeostasis and regulation of body mass in female mice. Erythropoietin regulates fat mass in male but not female mice on high-fat diets. Female estrogen receptor alpha deletion restores erythropoietin fat mass regulation. Estrogen receptor alpha deletion increases erythropoietin regulation of glucose tolerance. Erythropoietin reduced white fat-associated genes and increased uncoupling protein 1. Erythropoietin and estrogen cross-talk is implicated for metabolic homeostasis.
Collapse
Affiliation(s)
- Jeeyoung Lee
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mary F Walter
- Clinical Laboratory Core, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth S Korach
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Constance Tom Noguchi
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
11
|
Katsaridis S, Grammatikopoulou MG, Gkiouras K, Tzimos C, Papageorgiou ST, Markaki AG, Exiara T, Goulis DG, Papamitsou T. Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care. Nutrients 2020; 12:nu12113516. [PMID: 33203138 PMCID: PMC7696891 DOI: 10.3390/nu12113516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.
Collapse
Affiliation(s)
- Savvas Katsaridis
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Laboratory of Clinical Pharmacology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str, GR-54646 Thessaloniki, Greece;
| | - Stefanos T. Papageorgiou
- Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Anastasia G. Markaki
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hellenic Mediterranean University, PO Box 8556, Trypitos, GR-72300 Sitia, Greece;
| | - Triada Exiara
- Department of Internal Medicine, Sismanoglio General Hospital, 45 Sismanogliou Str, GR-69133 Komotini, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
| |
Collapse
|
12
|
Chrysant SG. The cardiometabolic benefits of exercise in postmenopausal women. J Clin Hypertens (Greenwich) 2020; 22:1691-1693. [PMID: 32964650 DOI: 10.1111/jch.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
13
|
Stamatelopoulos K, Tsoltos N, Armeni E, Paschou SA, Augoulea A, Kaparos G, Rizos D, Karagouni I, Delialis D, Ioannou S, Apostolakis M, Makrakis E, Lambrinoudaki I. Physical activity is associated with lower arterial stiffness in normal‐weight postmenopausal women. J Clin Hypertens (Greenwich) 2020; 22:1682-1690. [DOI: 10.1111/jch.13954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Kimon Stamatelopoulos
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Nikolaos Tsoltos
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Stavroula A. Paschou
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Georgios Kaparos
- Hormonal and Biochemical Laboratory Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Demetrios Rizos
- Hormonal and Biochemical Laboratory Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Iliana Karagouni
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Dimitris Delialis
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Sophia Ioannou
- Vascular Laboratory Department of Therapeutics Alexandra Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Michail Apostolakis
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Evangelos Makrakis
- Third Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology Aretaieio Hospital, National and Kapodistrian University of Athens Athens Greece
| |
Collapse
|
14
|
The effect of metformin on vertebral marrow fat in postmenopausal women with newly diagnosed type 2 diabetes mellitus. ACTA ACUST UNITED AC 2020; 27:326-332. [DOI: 10.1097/gme.0000000000001473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
15
|
Forslund M, Landin-Wilhelmsen K, Trimpou P, Schmidt J, Brännström M, Dahlgren E. Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution. Hum Reprod Open 2020; 2020:hoz042. [PMID: 31976382 PMCID: PMC6964225 DOI: 10.1093/hropen/hoz042] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/10/2019] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when lifestyle factors were similar to controls. WHAT IS KNOWN ALREADY Women with PCOS have an increased prevalence of T2DM. STUDY DESIGN SIZE DURATION A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls. PARTICIPANTS/MATERIALS SETTING METHODS Women with PCOS (n = 27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38-68 years, served as controls (n = 94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline. MAIN RESULTS AND THE ROLE OF CHANCE None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P < 0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period. LIMITATIONS REASONS FOR CAUTION The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain. WIDER IMPLICATIONS OF THE FINDINGS Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time. STUDY FUNDING/COMPETING INTERESTS The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.
Collapse
Affiliation(s)
- M Forslund
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
| | - K Landin-Wilhelmsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.,Section for Endocrinology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - P Trimpou
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.,Section for Endocrinology, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - J Schmidt
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - M Brännström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
| | - E Dahlgren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, 413 45 Gothenburg, Sweden
| |
Collapse
|
16
|
Paschou SA, Papanas N. Type 2 Diabetes Mellitus and Menopausal Hormone Therapy: An Update. Diabetes Ther 2019; 10:2313-2320. [PMID: 31549295 PMCID: PMC6848654 DOI: 10.1007/s13300-019-00695-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 01/02/2023] Open
Abstract
During menopausal transition, various phenotypical and metabolic changes occur, affecting body weight, adipose tissue distribution and energy expenditure as well as insulin secretion and sensitivity. Taken together, these can predispose women to the development of type 2 diabetes mellitus (T2DM). Many women in midlife experience climacteric symptoms, including hot flashes and night sweats. Menopausal hormone therapy (MHT) is then indicated. MHT has a favourable effect on glucose homeostasis in both women without and with T2DM. T2DM was considered in the past as a cardiovascular disease (CVD) equivalent, which would suggest that women with T2DM should not receive MHT. This notion may still deter many clinicians from prescribing MHT to these patients. However, nowadays there is strong evidence to support an individualised approach after careful evaluation of CVD risk. In older women with T2DM (> 60 years old or > 10 years in menopause), MHT should not be initiated, because it may destabilise mature atherosclerotic plaques, resulting in thrombotic episodes. In obese women with T2DM or in women with moderate CVD risk, transdermal 17β-oestradiol could be used. This route of delivery presents beneficial effects regarding triglyceride concentrations and coagulation factors. In peri- or recently post-menopausal diabetic women with low risk for CVD, oral oestrogens can be used, since they exhibit stronger beneficial effects on glucose and lipid profiles. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as natural progesterone, dydrogesterone or transdermal norethisterone. The goal is to maximise benefits and minimise adverse effects.
Collapse
Affiliation(s)
- Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| |
Collapse
|
17
|
Affiliation(s)
- Stavroula A Paschou
- Division of Endocrinology and Diabetes, Medical School, Aghia Sophia Hospital, National and Kapodistrian University of Athens, Athens, Greece - .,Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece -
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| |
Collapse
|