The relationship of menstrual irregularity to type 2 diabetes in Pima Indian women.
OBJECTIVE
Menstrual irregularity is associated with hyperinsulinemia and hyperandrogenemia in nondiabetic Pima Indian women of child-bearing age. In this population-based study, we determined the relationship of menstrual irregularity to type 2 diabetes in Pima Indian women.


METHODS
Participants for this cross-sectional analysis were 695 nonpregnant Pima Indian women, aged 18-44 years, involved in an ongoing epidemiologic study of diabetes among residents of the Gila River Indian Community of Arizona. Clinical data were collected by questionnaire and an examination that included a 75-g oral glucose tolerance test; diabetes was diagnosed by World Health Organization criteria. Menstrual irregularity was defined as an interval of 3 months or more between menses, when not pregnant, since age 18 years.


RESULTS
History of menstrual irregularity was significantly associated with a high prevalence of diabetes (37 vs. 13%; odds ratio = 4.2, 95% CI = 1.6-10.8) in the least obese women (BMI < 30 kg/m2), adjusted for the effects of age and overall obesity. This association was, in part, because of greater central obesity in women with irregular menses. In more obese women, there was little association with menstrual irregularity, and diabetes was frequent regardless of menstrual history.


CONCLUSIONS
Prevalence of type 2 diabetes is higher among Pima indian women with a history of menstrual irregularity. The difference is most pronounced among the least obese group of women. This association may be because of insulin resistance and hyperinsulinemia, which predict type 2 diabetes, also causing hyperandrogenism and menstrual irregularity. The findings reinforce the need to evaluate women with menstrual irregularity for hyperglycemia.
Roumain
J
J
Diabetes and Arthritis Epidemiology, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Disease, AZ 85014 USA. janine_roumain@nih.gov
Charles
M A
MA
de Courten
M P
MP
Hanson
R L
RL
Brodie
T D
TD
Pettitt
D J
DJ
Knowler
W C
WC
D000328:Adult; D001130:Arizona / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001824:Body Constitution; D015992:Body Mass Index; D001835:Body Weight; D003276:Contraceptives, Oral / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007198:Indians, North American; D008137:Longitudinal Studies; D008599:Menstruation Disturbances / Q000503:physiopathology*; D009765:Obesity / Q000503:physiopathology; D016017:Odds Ratio; D015995:Prevalence; D013997:Time Factors
D001786:Blood Glucose; D003276:Contraceptives, Oral; D006442:Glycated Hemoglobin