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Li Z, Yardley JE, Zaharieva DP, Riddell MC, Gal RL, Calhoun P. Changing Glucose Levels During the Menstrual Cycle as Observed in Adults in the Type 1 Diabetes Exercise Initiative Study. Can J Diabetes 2024:S1499-2671(24)00128-X. [PMID: 38972477 DOI: 10.1016/j.jcjd.2024.06.004] [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: 11/30/2023] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES Evidence suggests that glucose levels in menstruating females with type 1 diabetes change throughout the menstrual cycle, reaching a peak during the luteal phase. The Type 1 Diabetes Exercise Initiative (T1DEXI) study provided the opportunity to assess glycemic metrics between early and late phases of the menstrual cycle, and whether differences could be explained by exercise, insulin, and carbohydrate intake. METHODS One hundred seventy-nine women were included in our analysis. Glycemic metrics, carbohydrate intake, insulin requirements, and exercise habits during the early vs late phases of their menstrual cycles (i.e. 2 to 4 days after vs 2 to 4 days before reported menstruation start date) were compared. RESULTS Mean glucose increased from 8.2±1.5 mmol/L (148±27 mg/dL) during the early follicular phase to 8.6±1.6 mmol/L (155±29 mg/dL) during the late luteal phase (p<0.001). Mean percent time-in-range (3.9 to 10.0 mmol/L [70 to 180 mg/dL]) decreased from 73±17% to 70±18% (p=0.002), and median percent time >10.0 mmol/L (>180 mg/dL) increased from 21% to 23% (p<0.001). Median total daily insulin requirements increased from 37.4 units during the early follicular phase to 38.5 units during the late luteal phase (p=0.02) and mean daily carbohydrate consumption increased slightly from 127±47 g to 133±47 g (p=0.05); however, the difference in mean glucose during early follicular vs late luteal phase was not explained by differences in exercise duration, total daily insulin units, or reported carbohydrate intake. CONCLUSIONS Glucose levels during the late luteal phase were higher than those of the early follicular phase of the menstrual cycle. These glycemic changes suggest that glucose management for women with type 1 diabetes may need to be fine-tuned within the context of their menstrual cycles.
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Affiliation(s)
- Zoey Li
- Jaeb Center for Health Research, Tampa, Florida, United States.
| | - Jane E Yardley
- Department of Physcial Education, University of Alberta, Augustana Campus, Camrose, Alberta, Canada
| | - Dessi P Zaharieva
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Palo Alto, California, United States
| | - Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, United States
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, United States
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2
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Héritier H, Allémann C, Balakiriev O, Boulanger V, Carroll SF, Froidevaux N, Hugon G, Jaquet Y, Kebaili D, Riccardi S, Rousseau-Leupin G, Salathé RM, Salzmann T, Singh R, Symul L, Ugurlu-Baud E, de Verteuil P, Salathé M. Food & You: A digital cohort on personalized nutrition. PLOS DIGITAL HEALTH 2023; 2:e0000389. [PMID: 38033170 PMCID: PMC10688868 DOI: 10.1371/journal.pdig.0000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023]
Abstract
Nutrition is a key contributor to health. Recently, several studies have identified associations between factors such as microbiota composition and health-related responses to dietary intake, raising the potential of personalized nutritional recommendations. To further our understanding of personalized nutrition, detailed individual data must be collected from participants in their day-to-day lives. However, this is challenging in conventional studies that require clinical measurements and site visits. So-called digital or remote cohorts allow in situ data collection on a daily basis through mobile applications, online services, and wearable sensors, but they raise questions about study retention and data quality. "Food & You" is a personalized nutrition study implemented as a digital cohort in which participants track food intake, physical activity, gut microbiota, glycemia, and other data for two to four weeks. Here, we describe the study protocol, report on study completion rates, and describe the collected data, focusing on assessing their quality and reliability. Overall, the study collected data from over 1000 participants, including high-resolution data of nutritional intake of more than 46 million kcal collected from 315,126 dishes over 23,335 participant days, 1,470,030 blood glucose measurements, 49,110 survey responses, and 1,024 stool samples for gut microbiota analysis. Retention was high, with over 60% of the enrolled participants completing the study. Various data quality assessment efforts suggest the captured high-resolution nutritional data accurately reflect individual diet patterns, paving the way for digital cohorts as a typical study design for personalized nutrition.
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Affiliation(s)
- Harris Héritier
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Chloé Allémann
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Oleksandr Balakiriev
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Victor Boulanger
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Sean F. Carroll
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Noé Froidevaux
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Germain Hugon
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Yannis Jaquet
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Djilani Kebaili
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Sandra Riccardi
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Geneviève Rousseau-Leupin
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Rahel M. Salathé
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Talia Salzmann
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Rohan Singh
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Laura Symul
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
- Department of Statistics, Stanford University, Stanford, California, United States of America
| | - Elif Ugurlu-Baud
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Peter de Verteuil
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
| | - Marcel Salathé
- Digital Epidemiology Lab, School of Life Sciences, School of Computer and Communication Sciences, EPFL, Lausanne, Switzerland
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3
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Mewes D, Wäldchen M, Knoll C, Raile K, Braune K. Variability of Glycemic Outcomes and Insulin Requirements Throughout the Menstrual Cycle: A Qualitative Study on Women With Type 1 Diabetes Using an Open-Source Automated Insulin Delivery System. J Diabetes Sci Technol 2023; 17:1304-1316. [PMID: 35254146 PMCID: PMC10563528 DOI: 10.1177/19322968221080199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of hormone dynamics throughout the menstrual cycle on insulin sensitivity represents a currently under-researched area. Despite therapeutic and technological advances, self-managing insulin therapy remains challenging for women with type 1 diabetes (T1D). METHODS To investigate perceived changes in glycemic levels and insulin requirements throughout the menstrual cycle and different phases of life, we performed semi-structured interviews with 12 women with T1D who are using personalized open-source automated insulin delivery (AID) systems. Transcripts were analyzed using thematic analysis with an inductive, hypothesis-generating approach. RESULTS Participants reported significant differences between the follicular phase, ovulation, and luteal phase of the menstrual cycle and also during puberty, pregnancy, and menopause. All participants reported increased comfort and safety since using AID, but were still required to manually adjust their therapy according to their cycle. A lack of information and awareness and limited guidance by health care providers were frequently mentioned. Although individual adjustment strategies exist, achieving optimum outcomes was still perceived as challenging. CONCLUSIONS This study highlights that scientific evidence, therapeutic options, and professional guidance on female health-related aspects in T1D are insufficient to date. Further efforts are required to better inform people with T1D, as well as for health care professionals, researchers, medical device manufacturers, and regulatory bodies to better address female health needs in therapeutic advances.
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Affiliation(s)
- Darius Mewes
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Mandy Wäldchen
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Christine Knoll
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- School of Sociology, University College Dublin, Dublin, Ireland
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Katarina Braune
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
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4
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Lin G, Siddiqui R, Lin Z, Blodgett JM, Patel SN, Truong KN, Mariakakis A. Blood glucose variance measured by continuous glucose monitors across the menstrual cycle. NPJ Digit Med 2023; 6:140. [PMID: 37567949 PMCID: PMC10421863 DOI: 10.1038/s41746-023-00884-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Past studies on how blood glucose levels vary across the menstrual cycle have largely shown inconsistent results based on limited blood draws. In this study, 49 individuals wore a Dexcom G6 continuous glucose monitor and a Fitbit Sense smartwatch while measuring their menstrual hormones and self-reporting characteristics of their menstrual cycles daily. The average duration of participation was 79.3 ± 21.2 days, leading to a total of 149 cycles and 554 phases in our dataset. We use periodic restricted cubic splines to evaluate the relationship between blood glucose and the menstrual cycle, after which we assess phase-based changes in daily median glucose level and associated physiological parameters using mixed-effects models. Results indicate that daily median glucose levels increase and decrease in a biphasic pattern, with maximum levels occurring during the luteal phase and minimum levels occurring during the late-follicular phase. These trends are robust to adjustments for participant characteristics (e.g., age, BMI, weight) and self-reported menstrual experiences (e.g., food cravings, bloating, fatigue). We identify negative associations between each of daily estrogen level, step count, and low degrees of fatigue with higher median glucose levels. Conversely, we find positive associations between higher food cravings and higher median glucose levels. This study suggests that blood glucose could be an important parameter for understanding menstrual health, prompting further investigation into how the menstrual cycle influences glucose fluctuation.
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Affiliation(s)
- Georgianna Lin
- University of Toronto, Computer Science, Toronto, ON, Canada.
| | | | - Zixiong Lin
- University of Toronto, Computer Science, Toronto, ON, Canada
| | - Joanna M Blodgett
- University College London, Institute of Sport Exercise & Health, London, UK
| | - Shwetak N Patel
- University of Washington, Computer Science & Engineering, Seattle, WA, USA
| | - Khai N Truong
- University of Toronto, Computer Science, Toronto, ON, Canada
| | - Alex Mariakakis
- University of Toronto, Computer Science, Toronto, ON, Canada
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5
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Chen J, Zhu Y, Li Z, Zhang Y, Ye G, Chen K, Zhuo X, Zhang S, Lin L, Zhuo Y. Trends in prevalence rates of blindness among patients with diabetic retinopathy in high-income countries from 1990 to 2019: A joinpoint regression analysis. Diabetes Res Clin Pract 2023:110823. [PMID: 37429361 DOI: 10.1016/j.diabres.2023.110823] [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: 05/29/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
AIMS Diabetic retinopathy (DR) is the leading cause of blindness in patients with diabetes mellitus (DM). We investigated its trends in high-income countries to gain insights into preventing DR-related blindness in diabetes-epidemic areas. METHODS For joinpoint regression analysis, we extracted data from the Global Burden of Disease 2019 study and analysed the prevalence trends of DR-related blindness according to DM type, patients' sex and age, region, and nation. RESULTS Overall, the age-standardised prevalence rate (ASPR) of DR-related blindness has decreased. The prevalence rates of blindness decreased more sharply for Type 1 DM than for Type 2 DM. The ASPR was higher and the decreasing trend was less pronounced in women than in men. Southern Latin America had the highest ASPR, whereas Australasia had the lowest ASPR. Singapore experienced the greatest decline, whereas unfavourable trends were observed in the USA. CONCLUSIONS Despite decrease in the overall ASPR of DR-related blindness during the study period, large improvement opportunities were identified. As DM prevalence increases and the population ages rapidly in high-income countries, novel effective screening, treatment, and prevention strategies are urgently needed to improve the visual outcomes of individuals with DM or at risk of DM.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Kezhe Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Xiaohua Zhuo
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong 518040, China
| | - Shaochong Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong 518040, China.
| | - Lifeng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China.
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6
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Armstrong M, Colberg SR, Sigal RJ. Where to Start? Physical Assessment, Readiness, and Exercise Recommendations for People With Type 1 or Type 2 Diabetes. Diabetes Spectr 2023; 36:105-113. [PMID: 37193205 PMCID: PMC10182968 DOI: 10.2337/dsi22-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Exercise plays an important role in the management of diabetes and is associated with many benefits such as decreased morbidity and mortality. For people exhibiting signs and symptoms of cardiovascular disease, pre-exercise medical clearance is warranted; however, requiring broad screening requirements can lead to unnecessary barriers to initiating an exercise program. Robust evidence supports the promotion of both aerobic and resistance training, with evidence emerging on the importance of reducing sedentary time. For people with type 1 diabetes, there are special considerations, including hypoglycemia risk and prevention, exercise timing (including prandial status), and differences in glycemic responses based on biological sex.
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Affiliation(s)
- Marni Armstrong
- Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheri R. Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | - Ronald J. Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Gamarra E, Trimboli P. Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review. J Pers Med 2023; 13:jpm13020374. [PMID: 36836608 PMCID: PMC9962060 DOI: 10.3390/jpm13020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.
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Affiliation(s)
- Elena Gamarra
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), 6501 Bellinzona, Switzerland
- Correspondence:
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), 6501 Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
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8
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Toor S, Yardley JE, Momeni Z. Type 1 Diabetes and the Menstrual Cycle: Where/How Does Exercise Fit in? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2772. [PMID: 36833469 PMCID: PMC9957258 DOI: 10.3390/ijerph20042772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Regular exercise is associated with substantial health benefits for individuals with type 1 diabetes (T1D). However, the fear of hypoglycemia (low blood glucose) due to activity-induced declines in blood glucose levels acts as a major barrier to partaking in exercise in this population. For females with T1D, hormonal fluctuations during the menstrual cycle and their effects on blood glucose levels can act as an additional barrier. The impact that these cyclic changes may have on blood glucose and insulin needs and the consequent risk of hypoglycemia during or after exercise are still unknown in this population. Therefore, in this narrative review, we gathered existing knowledge about the menstrual cycle in T1D and the effects of different cyclic phases on substrate metabolism and glucose response to exercise in females with T1D to increase knowledge and understanding around exercise in this underrepresented population. This increased knowledge in such an understudied area can help to better inform exercise guidelines for females with T1D. It can also play an important role in eliminating a significant barrier to exercise in this population, which has the potential to increase activity, improve mental health and quality of life, and decrease the risk of diabetes-related complications.
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Affiliation(s)
- Saru Toor
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Immunology and Infection Program, Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Jane E. Yardley
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Zeinab Momeni
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
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9
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No Indices of Increased Type 2 Diabetes Risk in Individuals with Reactive Postprandial Hypoglycemia. Metabolites 2022; 12:metabo12121232. [PMID: 36557270 PMCID: PMC9787184 DOI: 10.3390/metabo12121232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Reactive postprandial hypoglycemia (RPH) is an understudied condition that lacks clinical definition, knowledge of future health implications, and an understanding of precise underlying mechanisms. Therefore, our study aimed to assess the glycemic response after glucose ingestion in individuals several years after the initial evaluation of RPH and to compare glucose regulation in individuals with RPH vs. healthy volunteers. We assessed the inter- and intra-individual differences in glucose, insulin, and C-peptide concentrations during 5-h oral glucose tolerance tests (OGTTs); the surrogate markers of insulin resistance (HOMA-IR and Matsuda index); and beta-cell function (distribution index and insulinogenic index). The study included 29 subjects with RPH (all females, aged 39 (28, 46) years) and 11 sex-, age-, and body mass index (BMI)-matched controls. No biochemical deterioration of beta-cell secretory capacity and no progression to dysglycemia after 6.4 ± 4.2 years of follow-up were detected. RPH subjects were not insulin resistant, and their insulin sensitivity did not deteriorate. RPH subjects exhibited no differences in concentrations or in the shape of the glucose-insulin curves during the 5-h OGTTs compared to age- and BMI-matched controls. No increased incident type 2 diabetes risk indices were evident in individuals with RPH. This dictates the need for further research to investigate the magnitude of future diabetes risk in individuals experiencing RPH.
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10
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Diaz C JL, Fabris C, Breton MD, Cengiz E. Insulin Replacement Across the Menstrual Cycle in Women with Type 1 Diabetes: An In Silico Assessment of the Need for Ad Hoc Technology. Diabetes Technol Ther 2022; 24:832-841. [PMID: 35714349 DOI: 10.1089/dia.2022.0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Women with type 1 diabetes (T1D) of fertile age may experience fluctuations in insulin needs across the menstrual cycle. When present, these fluctuations complicate glucose management and oftentimes worsen glycemic control. In this work, an in silico analysis was conducted to assess whether current technology is sufficient to handle changes in insulin needs due to the menstrual cycle in women with T1D. Methods: Euglycemic clamp studies were performed in 16 women with T1D in the follicular phase (FP) and luteal phase (LP) of the menstrual cycle. Interphase insulin sensitivity (IS) variability observed in the data was modeled and introduced in the University of Virginia/Padova T1D Simulator. Open-loop and closed-loop insulin delivery was tested in two in silico studies, without (nominal study) and with (informed study) a priori knowledge on cycle-related IS variability informing insulin therapy. Glycemic metrics were computed on the obtained glucose traces. Results: In the pool of studied women, the glucose infusion rate area under the curve significantly decreased from FP to LP (P = 0.0107), indicating an average decrease of IS in LP. When introduced in the simulator, this pattern led to increased time spent >180 and >250 mg/dL during LP versus FP in the nominal studies, irrespective of the insulin delivery strategy. In the informed studies, glycemic metrics stabilized across the cycle. Conclusion: This work suggests that current insulin delivery technology may benefit from informing the dosing algorithm with knowledge on menstrual cycle related IS changes. Clinical validation of these results is warranted. ClinicalTrials.gov identifier: NCT02693938.
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Affiliation(s)
- Jenny L Diaz C
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Chiara Fabris
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Eda Cengiz
- Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, California, USA
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11
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Tatulashvili S, Baptiste Julla J, Sritharan N, Rezgani I, Levy V, Bihan H, Riveline JP, Cosson E. Ambulatory Glucose Profile According to Different Phases of the Menstrual Cycle in Women Living With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:2793-2800. [PMID: 35869507 DOI: 10.1210/clinem/dgac443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT Some women living with type 1 diabetes complain of changes in glucose values according to the different phases of menstruation. OBJECTIVE To evaluate this variability through continuous glucose monitoring (CGM) data in type 1 diabetes patients. DESIGN Observational study. SETTING Ambulatory data, recruitment in 2 centers in the Paris region. PATIENTS Twenty-four women with type 1 diabetes having spontaneous menstrual cycles. INTERVENTION Collection of CGM data for 62 spontaneous menstrual cycles, with evaluation of five 3-day phases during each cycle: (1) early follicular (menstruations), (2) mid-follicular, (3) peri-ovulatory, (4) mid-luteal, and (5) late luteal. MAIN OUTCOME MEASURE Time in range (TIR, prespecified). RESULTS TIR decreased for each consecutive phase (61 ± 18%; 59 ± 18%; 59 ± 20%; 57 ± 18%; and 55 ± 20%, P = 0.02). The linear mixed model highlighted a decrease in TIR in the mid-luteal (P = 0.03) and late luteal (P < 0.001) phases compared with the early follicular phase. Time above range was significantly higher during the late luteal phase than the early follicular phase (P = 0.003). Time below range was significantly higher during the mid-follicular phase than in the early follicular phase. CONCLUSION In most of the study population, glucose levels rose linearly throughout the menstrual cycle, reaching a maximum in the late luteal phase. A sharp decrease was seen for most participants at the beginning of menstrual bleeding. This should be taken into consideration in daily care of type 1 diabetes patients to avoid hypoglycemia.
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Affiliation(s)
- Sopio Tatulashvili
- AP-HP, Endocrinology, Diabetes and Metabolic Diseases Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Paris Nord, Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Jean Baptiste Julla
- AP-HP, Endocrinology and Diabetes Unit, Lariboisiere Hospital, University of Paris-Cité, 75010 Paris, France
- Unite INSERM U1151 Immunity and Metabolism in Diabetes, ImMeDiab Team, Institut Necker Enfants Malades, and Universite de Paris, Paris 75015, France
| | - Nanthara Sritharan
- AP-HP, Clinical Research Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
| | - Imen Rezgani
- AP-HP, Endocrinology, Diabetes and Metabolic Diseases Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
| | - Vincent Levy
- AP-HP, Clinical Research Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
| | - Helene Bihan
- AP-HP, Endocrinology, Diabetes and Metabolic Diseases Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
| | - Jean-Pierre Riveline
- AP-HP, Endocrinology and Diabetes Unit, Lariboisiere Hospital, University of Paris-Cité, 75010 Paris, France
- Unite INSERM U1151 Immunity and Metabolism in Diabetes, ImMeDiab Team, Institut Necker Enfants Malades, and Universite de Paris, Paris 75015, France
| | - Emmanuel Cosson
- AP-HP, Endocrinology, Diabetes and Metabolic Diseases Unit, Avicenne Hospital, SMBH Paris 13, 93000 Bobigny, France
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Paris Nord, Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
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12
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Levy CJ, O'Malley G, Raghinaru D, Kudva YC, Laffel LM, Pinsker JE, Lum JW, Brown SA. Insulin Delivery and Glucose Variability Throughout the Menstrual Cycle on Closed Loop Control for Women with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:357-361. [PMID: 35099294 PMCID: PMC9127830 DOI: 10.1089/dia.2021.0431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: To analyze insulin delivery and glycemic metrics throughout the menstrual cycle for women with type 1 diabetes using closed loop control (CLC) insulin delivery. Methods: Menstruating women using a CLC system in a clinical trial were invited to record their menstrual cycles through a cycle-tracking application. Sixteen participants provided data for this secondary analysis over three or more complete cycles. Insulin delivery and continuous glucose monitoring (CGM) data were analyzed in relation to reported cycle phases. Results: Insulin delivery and CGM metrics remained consistent during cycle phases. Intraparticipant variability of CGM metrics and weight-based insulin delivery did not change through cycle phases. Conclusions: For this sample of menstruating women with type 1 diabetes using a CLC system, insulin delivery and glycemic metrics remained stable throughout menstrual cycle phases. Additional studies in this population are needed, particularly among women who report variable glycemic control during their cycles. Trial Registration: NCT03591354.
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Affiliation(s)
- Carol J. Levy
- Deparment of Medicine, Endocrinology, Diabetes and Bone Diseases, Mount Sinai Diabetes Center, New York, New York, USA
| | - Grenye O'Malley
- Deparment of Medicine, Endocrinology, Diabetes and Bone Diseases, Mount Sinai Diabetes Center, New York, New York, USA
| | - Dan Raghinaru
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Yogish C. Kudva
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lori M. Laffel
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | | | - John W. Lum
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Sue A. Brown
- Endocrinology and Metabolism Division, Department of Medicine, Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
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13
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Celik A, Forde R, Racaru S, Forbes A, Sturt J. The Impact of Type 2 Diabetes on Women's Health and Well-being During Their Reproductive Years: A Mixed-methods Systematic Review. Curr Diabetes Rev 2022; 18:e011821190403. [PMID: 33461469 DOI: 10.2174/1573399817666210118144743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The incidence of Type 2 Diabetes (T2DM) among younger women now accounts for 40% of females with T2DM. Women of reproductive age with T2DM have additional health considerations and their needs may differ from older populations. OBJECTIVES The aims were (1) to identify the health issues encountered by women aged 16-45 years living with T2DM; (2) to determine the modifiable risk factors associated with living with diabetes; (3) to specify ideas for interventions to meet age and gender-specific diabetes-related healthcare needs. METHODS A systematic search was performed in the following databases; MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Maternity and Infant Care. Databases were searched without time and study design limits. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Data were narratively synthesised due to mixed methods evidence included. RESULTS A total of 32 papers were included in the review from which six domains were identified from the synthesis: (1) diabetes related modifiable risk factors: blood glucose, cardiovascular risk, neuropathy/nephropathy/retinopathy, diabetes self-management barriers (2) reproductive health: diabetes care before pregnancy, pre-pregnancy care barriers and expectations of women, contraceptive use (3) psychosocial wellbeing: depression symptoms and diabetes distress, perception of T2DM, emotional concerns about pregnancy (4) sexual function; (5) menopause; (6) sociocultural factors: social support, cultural norms. CONCLUSION This review highlighted specific health issues affecting women of reproductive age with T2DM and which represent an important focus for health services research and health care delivery. Future research needs to address identified health domains to improve women's health and well-being living with T2DM.
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Affiliation(s)
- Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Simona Racaru
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
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14
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Diaz C JL, Cengiz E, Breton MD, Fabris C. Modeling the variability of insulin sensitivity during the menstrual cycle in women with type 1 diabetes to adjust open-loop insulin therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1543-1546. [PMID: 34891578 DOI: 10.1109/embc46164.2021.9629785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Women with type 1 diabetes (T1D) typically experience a decrease in insulin sensitivity (SI) during the second half of their menstrual cycle (or the luteal phase (LP)), which oftentimes is not properly addressed by insulin therapy, therefore leading to increased exposure to hyperglycemia. This study proposes a suitable way to model SI variability due to the menstrual cycle in the FDA-accepted University of Virginia (UVA)/Padova T1D Simulator, to determine to what extent the inclusion of menstrual cycle information to fine-tune insulin therapy could help improve glycemic control in the LP of the menstrual cycle. In-silico tests were performed considering different simulation scenarios, and the obtained results show that hyperglycemic excursions can be largely reduced when SI variability is taken into account for planning insulin therapy, without a relevant increase in hypoglycemic events.
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15
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Deshmukh H, Wilmot EG, Gregory R, Barnes D, Narendran P, Saunders S, Furlong N, Kamaruddin S, Banatwalla R, Herring R, Kilvert A, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Predictors of diabetes-related distress before and after FreeStyle Libre-1 use: Lessons from the Association of British Clinical Diabetologists nationwide study. Diabetes Obes Metab 2021; 23:2261-2268. [PMID: 34142425 DOI: 10.1111/dom.14467] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
AIM To identify the baseline demographic and clinical characteristics associated with diabetes-related distress (DRD) and factors associated with improvement in DRD after initiating use of the FreeStyle Libre (FSL) in people living with type 1 diabetes (T1D). METHODS The study was performed using baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes who initiated use of the FSL in the United Kingdom. DRD was assessed using the two-item diabetes-related distress scale (DDS; defined as the average of the two-item score ≥3). People living with T1D were categorized into two groups: those with high DRD, defined as an average DDS score ≥3 and those with lower DRD, defined as a DDS score <3. We used a gradient-boosting machine-learning (GBM) model to identify the relative influence (RI) of baseline variables on average DDS score. RESULTS The study population consisted of 9159 patients, 96.6% of whom had T1D. The median (interquartile range [IQR]) age was 45.1 (32-56) years, 50.1% were women, the median (IQR) baseline body mass index was 26.1 (23.2-29.6) kg/m2 and the median (IQR) duration of diabetes was 20 (11-32) years. The two components of the DDS were significantly correlated (r2 = 0.73; P < 0.0001). Higher DRD was prevalent in 53% (4879/9159) of people living with T1D at baseline. In the GBM model, the top baseline variables associated with average DDS score were baseline glycated haemoglobin (HbA1c; RI = 51.1), baseline Gold score (RI = 23.3), gender (RI = 7.05) and fear of hypoglycaemia (RI = 4.96). Follow-up data were available for 3312 participants. The top factors associated with improvement in DDS score following use of the FSL were change in Gold score (RI = 28.2) and change in baseline HbA1c (RI = 19.3). CONCLUSIONS In this large UK cohort of people living with T1D, diabetes distress was prevalent and associated with higher HbA1c, impaired awareness of hypoglycaemia and female gender. Improvement in glycaemic control and hypoglycaemia unawareness with the use of the FSL was associated with improvement in DRD in people living with T1D.
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Affiliation(s)
- Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Parth Narendran
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Simon Saunders
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Niall Furlong
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | | | | | | | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
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16
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Sayegh M, Henderson J, Farquharson AJ, Horgan G, Ranawana V, Drew JE. Inter-Individual Variation in Postprandial Glycemic Responses in Women Co-Ingesting Green Leafy Vegetables with a Carbohydrate Meal: Interactions with the Sirtuin System. Mol Nutr Food Res 2021; 65:e2000923. [PMID: 33852192 DOI: 10.1002/mnfr.202000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/17/2021] [Indexed: 11/12/2022]
Abstract
SCOPE Green leafy vegetables (GLV) may improve postprandial glycemic responses (PGR) and metabolic health. However, inter-individual variations (IIV) preclude conclusive evidence. Sirtuin system is emerging as a key player in blood glucose control. This study investigates IIV in PGR in women co-ingesting GLV with a carbohydrate meal and interactions with the sirtuin system. METHODS AND RESULTS Volunteers (n = 31 women) consume rice, rice with bok choy, or spinach (75g available carbohydrate) on separate occasions. Postprandial glucose, insulin, adropin, and lipid levels are measured. Anthropometric measurements and sex hormones are measured. GeXP assay measures whole blood postprandial gene expression profiles of 25 markers involved in sirtuin signaling. GLV consumption has no significant effect on PGR, which shows high variation. PGR correlated with age, but no other consistent associations are observed. Sirtuin gene expression profiles reveal distinct stratified subgroups associated with PGR, lipid, insulin, fat mass, waist/hip circumferences, and adropin levels. CONCLUSION PGR to co-ingesting GLV with a carbohydrate meal are highly variable in this cohort and fail to reveal a significant reduction in PGR. Variable responses are largely independent of menopausal status and meal consumed. However, lower expression of sirtuin gene targets is associated with higher PGR and with markers linked to health status.
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Affiliation(s)
- Marietta Sayegh
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Jaye Henderson
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Andrew J Farquharson
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Graham Horgan
- Biomathematics and Statistics Scotland, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Viren Ranawana
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Janice E Drew
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Thong EP, Burden C. The Double Whammy of Obesity and Diabetes on Female Reproductive Health. Semin Reprod Med 2021; 38:333-341. [PMID: 33598908 DOI: 10.1055/s-0041-1723777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The rising global prevalence of obesity and diabetes, especially in youth, confers substantial metabolic consequences and increased mortality in affected individuals. While obesity is strongly tied to the development of insulin resistance and type 2 diabetes, emerging evidence shows that obesity rates are also increasing exponentially in those with type 1 diabetes, contributing to insulin resistance and cardiometabolic sequelae. In addition, both obesity and diabetes can exert adverse effects on female reproductive health independently, with the presence of both conditions likely to exacerbate reproductive dysfunction in this cohort. If the current trends in obesity and diabetes incidence persist, it is likely that more women will be at risk of obesity- and diabetes-related reproductive disorders. This review aims to describe the epidemiology and mechanisms of obesity in women with diabetes, and summarize current literature regarding reproductive disorders in diabetes and weight management strategies in this cohort.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Christy Burden
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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18
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Xu X, Fan S, Guo Y, Tan R, Zhang J, Zhang W, Pan BX, Kato N. The effects of perinatal bisphenol A exposure on thyroid hormone homeostasis and glucose metabolism in the prefrontal cortex and hippocampus of rats. Brain Behav 2019; 9:e01225. [PMID: 30761779 PMCID: PMC6422808 DOI: 10.1002/brb3.1225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 10/25/2018] [Accepted: 12/09/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Bisphenol A (BPA) is an endocrine disruptor widely used to manufacture consumer goods. Although the thyroid hormone (TH) disrupting potential of BPA has been thought to be responsible for the neuropsychiatric deficits in the animals that experienced perinatal BPA exposure, the TH availability change at the level of specific brain structures has not been subject to systematic investigation. METHODS In the present study the impacts of perinatal BPA exposure (0.1 mg/L in drinking water) spanning gestation and lactation on TH homeostasis in the prefrontal cortex (PFC) and hippocampus were assessed in male Sprague-Dawley rats at postnatal day 21 (PND21) and PND90. As TH regulates brain glucose metabolism at multiple levels,the effects of BPA treatment on glucose metabolism in the brain tissues were also assessed in adult rats. RESULTS The results showed heterogeneous changes in TH concentration induced by BPA between serum and brain tissues, additionally, in the BPA-treated pups, up-regulated expression of the TH transporter monocarboxylate 8 mRNA at PND21 and increased type 3 iodothyronine deiodinase mRNA expressions at PND21 and PND90 were observed. Meanwhile, decreased glucose metabolism was seen in the PFC and hippocampus, while deficits in locomotor activity, spatial memory and social behaviors occurred in BPA-treated groups. CONCLUSION These data support the concept that the developing brain possesses potent mechanisms to compensate for a small reduction in serum TH, such as serum hypothyrodism induced by BPA exposure, however, the long-term negative effect of BPA treatment on TH homeostasis and glucose metabolism may be attributable to neuropsychiatric deficits after mature.
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Affiliation(s)
- Xiaobin Xu
- Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China
| | - Shijun Fan
- Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China
| | - Yuanqiao Guo
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Ruei Tan
- Tan Clinic, Tokyo, Kanagawa, Japan
| | - Junyu Zhang
- Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China
| | - Wenhua Zhang
- Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China
| | - Bing-Xing Pan
- Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China
| | - Nobumasa Kato
- Medical Institute of Developmental Disorders Research, Showa University, Tokyo, Japan
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19
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20
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Identifying and addressing gaps in reproductive health education for adolescent girls with type 1 diabetes. PLoS One 2018; 13:e0206102. [PMID: 30399169 PMCID: PMC6219771 DOI: 10.1371/journal.pone.0206102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
Aims Adolescent girls with diabetes are at risk for adverse pregnancy outcomes due to age, risk-taking behavior, poor glycemic control, and lack of knowledge. Our aims were to assess attitudes and behaviors related to reproductive health education (RHE) among diabetes healthcare providers and adolescent girls with diabetes, and to pilot a brief clinic-based RHE intervention. Methods We surveyed 29 providers and 50 adolescent girls with type 1 diabetes about RHE experiences, attitudes, and behaviors. We piloted the RHE intervention with 9 adolescent-parent dyads. Results 50% of providers were very uncomfortable discussing pregnancy or contraception. Most (72%) did not proactively initiate RHE; common barriers included insufficient time and subject knowledge. Fewer than 10% recommended long-acting reversible contraceptives. A minority (10%) of adolescents had discussed pregnancy or contraception with a provider. RHE sessions lasted a median of 16 (range 13–24) minutes, and there were promising trends for changes in adolescents’ self-efficacy and intentions to use contraception and seek preconception counseling and in their knowledge of reproductive health. Conclusion Adolescent girls with diabetes rarely receive education on pregnancy and contraception due to provider discomfort, limited knowledge, and limited time. RHE using easily-accessible materials with an educator may help address this gap in care.
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Moser O, Tschakert G, Mueller A, Groeschl W, Eckstein ML, Koehler G, Bracken RM, Pieber TR, Hofmann P. Different Heart Rate Patterns During Cardio-Pulmonary Exercise (CPX) Testing in Individuals With Type 1 Diabetes. Front Endocrinol (Lausanne) 2018; 9:585. [PMID: 30333794 PMCID: PMC6176070 DOI: 10.3389/fendo.2018.00585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/14/2018] [Indexed: 01/26/2023] Open
Abstract
To investigate the heart rate during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes (T1D) compared to healthy (CON) individuals. Fourteen people (seven individuals with T1D and seven CON individuals) performed a CPX test until volitional exhaustion to determine the first and second lactate turn points (LTP1 and LTP2), ventilatory thresholds (VT1 and VT2), and the heart rate turn point. For these thresholds cardio-respiratory variables and percentages of maximum heart rate, heart rate reserve, maximum oxygen uptake and oxygen uptake reserve, and maximum power output were compared between groups. Additionally, the degree and direction of the deflection of the heart rate to performance curve (kHR) were compared between groups. Individuals with T1D had similar heart rate at LTP1 (mean difference) -11, [(95% confidence interval) -27 to 4 b.min-1], at VT1 (-12, -8 to 33 b.min-1) and at LTP2 (-7, -13 to 26 b.min-1), at VT2 (-7, -13 to 28 b.min-1), and at the heart rate turn point (-5, -14 to 24 b.min-1) (p = 0.22). Heart rate expressed as percentage of maximum heart rate at LTP1, VT1, LTP2, VT2 and the heart rate turn point as well as expressed as percentages of heart rate reserve at LTP2, VT2 and the heart rate turn point was lower in individuals with T1D (p < 0.05). kHR was lower in T1D compared to CON individuals (0.11 ± 0.25 vs. 0.51 ± 0.32, p = 0.02). Our findings demonstrate that there are clear differences in the heart rate response during CPX testing in individuals with T1D compared to CON individuals. We suggest using submaximal markers to prescribe exercise intensity in people with T1D, as the heart rate at thresholds is influenced by kHR. Clinical Trial Identifier: NCT02075567 (https://clinicaltrials.gov/ct2/show/NCT02075567).
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Affiliation(s)
- Othmar Moser
- Exercise Physiology, Training Therapy & Training Research Group, Institute of Sports Sciences, University of Graz, Graz, Austria
- Division of Diabetology & Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Diabetes Research Group, School of Medicine, Swansea University, Swansea, United Kingdom
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
- *Correspondence: Othmar Moser
| | - Gerhard Tschakert
- Exercise Physiology, Training Therapy & Training Research Group, Institute of Sports Sciences, University of Graz, Graz, Austria
| | - Alexander Mueller
- Exercise Physiology, Training Therapy & Training Research Group, Institute of Sports Sciences, University of Graz, Graz, Austria
- Sports Science Laboratory, Institute of Health and Tourism Management, FH JOANNEUM-University of Applied Sciences, Bad Gleichenberg, Austria
| | - Werner Groeschl
- Exercise Physiology, Training Therapy & Training Research Group, Institute of Sports Sciences, University of Graz, Graz, Austria
| | - Max L. Eckstein
- Diabetes Research Group, School of Medicine, Swansea University, Swansea, United Kingdom
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
| | - Gerd Koehler
- Division of Diabetology & Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Richard M. Bracken
- Diabetes Research Group, School of Medicine, Swansea University, Swansea, United Kingdom
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, United Kingdom
| | - Thomas R. Pieber
- Division of Diabetology & Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training Therapy & Training Research Group, Institute of Sports Sciences, University of Graz, Graz, Austria
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Grotz VL, Pi-Sunyer X, Porte D, Roberts A, Richard Trout J. A 12-week randomized clinical trial investigating the potential for sucralose to affect glucose homeostasis. Regul Toxicol Pharmacol 2017; 88:22-33. [PMID: 28502831 DOI: 10.1016/j.yrtph.2017.05.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/05/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
The discovery of gut sweet taste receptors has led to speculations that non-nutritive sweeteners, including sucralose, may affect glucose control. A double-blind, parallel, randomized clinical trial, reported here and previously submitted to regulatory agencies, helps to clarify the role of sucralose in this regard. This was primarily an out-patient study, with 4-week screening, 12-week test, and 4-week follow-up phases. Normoglycemic male volunteers (47) consumed ∼333.3 mg encapsulated sucralose or placebo 3x/day at mealtimes. HbA1c, fasting glucose, insulin, and C-peptide were measured weekly. OGTTs were conducted in-clinic overnight, following overnight fasting twice during screening phase, twice during test phase, and once at follow-up. Throughout the study, glucose, insulin, C-peptide and HbA1c levels were within normal range. No statistically significant differences between sucralose and placebo groups in change from baseline for fasting glucose, insulin, C-peptide and HbA1c, no clinically meaningful differences in time to peak levels or return towards basal levels in OGTTs, and no treatment group differences in mean glucose, insulin, or C-peptide AUC change from baseline were observed. The results of other relevant clinical trials and studies of gastrointestinal sweet taste receptors are compared to these findings. The collective evidence supports that sucralose has no effect on glycemic control.
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Affiliation(s)
- V Lee Grotz
- McNeil Nutritionals, Fort Washington, PA 19034, United States.
| | - Xavier Pi-Sunyer
- Department of Medicine, Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY 10025, United States.
| | - Daniel Porte
- Department of Medicine, Division of Endocrinology and Metabolism, University of California San Diego, San Diego, CA, United States; Department of Medicine, Endocrinology, Diabetes and Metabolism Section, VA San Diego Health Care System, San Diego, CA, United States.
| | - Ashley Roberts
- Food & Nutrition Group, Intertek Scientific & Regulatory Consultancy, Mississauga, Ontario, Canada.
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Tanaka S, Hishiki M, Ogasawara J, Sorimachi E, Nakayama M. The Deterioration of the Glycemic Profile during Hormone Replacement Therapy in a Patient with Fulminant Type 1 Diabetes. Intern Med 2017; 56:531-534. [PMID: 28250300 PMCID: PMC5399205 DOI: 10.2169/internalmedicine.56.7663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although most women with type 1 diabetes experience the normal transition to menopause, there is little information about the impact of hormone replacement therapy on their glycemic profiles. A 54-year-old postmenopausal woman with fulminant type 1 diabetes was admitted to our hospital due to diabetic ketoacidosis. She was treated with fluid replacement and a continuous insulin infusion. Thereafter, her glycemic profile was well maintained by daily multiple insulin injections. However, her glycemic profiles immediately deteriorated following the administration of progesterone in hormone replacement therapy. This transient deterioration implies that external progesterone can lead to the deterioration of glycemic profiles in postmenopausal women with type 1 diabetes.
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Affiliation(s)
- Sho Tanaka
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Japan
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Garessus EDG, de Mutsert R, Visser AW, Rosendaal FR, Kloppenburg M. No association between impaired glucose metabolism and osteoarthritis. Osteoarthritis Cartilage 2016; 24:1541-7. [PMID: 27084351 DOI: 10.1016/j.joca.2016.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between markers of glucose metabolism and hand and knee osteoarthritis (OA). METHODS This is a cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity (NEO) study, a population-based prospective cohort study. Fasting glucose, insulin and glycated hemoglobulin A1c (HbA1c) concentrations were measured, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) was calculated and clinical OA was defined following the American College of Rheumatology (ACR) criteria. After exclusion of participants on glucose-lowering drugs, odds ratios (ORs) with 95% confidence intervals (CIs) for either hand, knee or both hand and knee OA were calculated (no OA as reference), as a function of each marker of glucose metabolism, with logistic regression analyses. Models were adjusted for age, ethnicity, education, height, weight and total body fat, and stratified by sex. RESULTS In 6197 participants (age 45-65 years, 56% women, mean body mass index (BMI) 26 kg/m(2)), prevalences of hand OA, knee OA or both were 7%, 10% or 4%, respectively. In men, the adjusted OR (95%CI) for hand OA was 1.18 (1.01-1.39) per standard deviation (SD) increase in plasma glucose (0.85 mmol/L). There were no further associations of glucose, HbA1c, insulin and HOMA-IR with the different types of OA, neither in men nor in women. CONCLUSION An impaired glucose metabolism does not seem be related to OA. In men, an association was observed for fasting glucose concentrations and hand OA. Future studies should investigate the presence of sex differences in the pathogenesis of hand OA.
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Affiliation(s)
- E D G Garessus
- Department of Rheumatology, Leiden University Medical Center, C1-R, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, C7-P, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
| | - A W Visser
- Department of Rheumatology, Leiden University Medical Center, C1-R, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, C7-P, P.O. Box 9600, Leiden 2300 RC, The Netherlands; Department of Thrombosis and Hemostasis, Leiden University Medical Center, C7-P, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, C1-R, P.O. Box 9600, Leiden 2300 RC, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, C7-P, P.O. Box 9600, Leiden 2300 RC, The Netherlands.
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Herranz L, Saez-de-Ibarra L, Hillman N, Gaspar R, Pallardo LF. Cambios glucémicos durante el ciclo menstrual en mujeres con diabetes mellitus tipo 1. Med Clin (Barc) 2016; 146:287-91. [DOI: 10.1016/j.medcli.2015.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
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Polsky S, Giordano D, Voelmle MK, Garcetti R, Garg SK. Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy. Postgrad Med 2016; 128:418-26. [PMID: 26924774 DOI: 10.1080/00325481.2016.1159910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of diabetes is increasing globally. Technology to improve care among individuals with diabetes is constantly being developed. Women living with Type 1 Diabetes Mellitus (T1DM) have unique challenges affecting their glucose control relating to menstrual cycles, pregnancy, and menopause. The purpose of this review is to examine the literature related to the use of technology to help women with T1DM manage their diabetes during the reproductive years, pregnancy, and beyond. Continuous subcutaneous insulin infusion (CSII) therapy can provider equivalent or better glucose control when compared with multiple daily injections (MDI), with less hypoglycemia, diabetic ketoacidosis, and weight gain. The CSII therapy has features that could help improve glucose control over the menstrual cycle, menopause, and pregnancy, although the most studied of these stages is pregnancy. Continuous glucose monitoring (CGM) can be combined with any insulin delivery system (MDI or CSII) to provide data on glucose values every few minutes and show glucose trends over time. CGM introduction can highlight glucose variability for women with T1DM, may be beneficial during pregnancy, and can reduce hypoglycemia. Sensor-augmented pump therapy and hybrid artificial pancreas (closed-loop) systems are promising tools that improve outcomes among individuals with diabetes. The use of modern technology to improve glucose and metabolic control among menopausal women with diabetes has not been well studied. Internet and phone-based technologies are emerging as important tools that may help with diabetes self-care for women living with diabetes.
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Affiliation(s)
- Sarit Polsky
- a Barbara Davis Center for Diabetes , Aurora , CO , USA
| | | | | | | | - Satish K Garg
- a Barbara Davis Center for Diabetes , Aurora , CO , USA
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Hillson R. Diabetes, menstruation, and the uterus. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brown SA, Jiang B, McElwee-Malloy M, Wakeman C, Breton MD. Fluctuations of Hyperglycemia and Insulin Sensitivity Are Linked to Menstrual Cycle Phases in Women With T1D. J Diabetes Sci Technol 2015; 9:1192-9. [PMID: 26468135 PMCID: PMC4667305 DOI: 10.1177/1932296815608400] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Factors influencing glycemic variability in type 1 diabetes (T1D) may play a significant role in the refinement of closed loop insulin administration. Phase of menstrual cycle is one such factor that has been inadequately investigated. We propose that unique individual patterns can be constructed and used as parameters of closed loop systems. METHOD Women with T1D on continuous subcutaneous insulin infusion and continuous glucose monitoring were studied for 3 consecutive menstrual cycles. Ovulation prediction kits and labs were used to confirm phase of menstrual cycle. Glycemic risks were assessed using the low- and high blood glucose indices (LBGI and HBGI). Insulin sensitivity (SI) was estimated using a Kalman filtering method from meal and insulin data. Overall change significance for glycemic risks was assessed by repeated measures ANOVA, with specific phases emphasized using contrasts. RESULTS Ovulation was confirmed in 33/36 cycles studied in 12 subjects (age = 33.1 ± 7.0 years, BMI = 25.7 ± 2.9 kg/m(2), A1c = 6.8 ± 0.7%). Risk for hyperglycemia changed significantly during the cycle (P = .023), with HBGI increasing until early luteal phase and returning to initial levels thereafter. LBGI was steady in the follicular phase, decreasing thereafter but not significantly. SI was depressed during the luteal phase when compared to the early follicular phase (P ≤ .05). Total daily insulin, carbohydrates, or calories did not show any significant fluctuations. CONCLUSIONS Women with T1D have glycemic variability changes that are specific to the individual and are linked to phase of cycle. An increased risk of hyperglycemia was observed during periovulation and early luteal phases compared to the early follicular phase; these changes appear to be associated with decreased insulin sensitivity during the luteal phase.
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Affiliation(s)
- Sue A Brown
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Division of Endocrinology, University of Virginia, Charlottesville, VA, USA
| | - Boyi Jiang
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | | | - Christian Wakeman
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
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Abstract
The purpose of this paper is to review male-female differences in the incidence and prevalence of diabetes and diabetic retinopathy. These differences will be established primarily through results from our present research and a review of related literature. Previously, we have demonstrated that neuroretinal dysfunction can be used to predict the location of future retinopathy up to three years before it is manifest. Our current research suggests that, for type 2 diabetes, the normal differences in neuroretinal function between nondiabetic males and females under 50 years of age are altered in patients with type 2 diabetes. Furthermore, local neuroretinal function in type 2 diabetes is more abnormal in adult males compared with adult females. The literature also suggests that there are male-female differences in the occurrence of diabetes. In adolescence, the incidence of type 1 diabetes is greater in males, whereas in type 2 diabetes, the incidence is greater in females. This excess of females in type 2 diabetes shifts to a more equal incidence between the two sexes in adults. In addition, advanced retinopathy in type 1 diabetes appears to be more common in males, and the presence and severity of diabetic retinopathy at the time of diagnosis in type 2 diabetes appears to be more associated with male sex. Although the reasons for male-female differences identified in this review are unknown, sex appears to be a significant factor in certain aspects of diabetes incidence and diabetic retinopathy.
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Affiliation(s)
- Glen Y Ozawa
- Berkeley School of Optometry, University of California , Berkeley, CA , USA
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