title: Effect of glycemic treatment and microvascular complications on menopause in women with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort.
abstract: OBJECTIVE We examined the impact of intensive versus conventional diabetes treatment upon menopause among women with type 1 diabetes in the Diabetes Control and Complications Trial (DCCT), a randomized controlled trial of intensive diabetes treatment, and its observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. RESEARCH DESIGN AND METHODS In a secondary analysis of women in the DCCT/EDIC (n = 657), outcomes were the cumulative incidences of natural menopause and surgical menopause. Cox regression analyses were used to examine associations with treatment group, time-varying estimates of hemoglobin A1c (HbA1c), insulin dosage, BMI, and microvascular complications (retinopathy, nephropathy, and neuropathy). RESULTS By EDIC year 18, after an average of 28 years of follow-up, 240 (38%) women had experienced natural menopause and 115 (18%) women had experienced surgical menopause. Age at natural menopause was similar in the intensive versus conventional groups (49.9 vs. 49.0 years; P = 0.28), and age at surgical menopause was similar in the intensive versus conventional groups (40.8 vs. 42.0 years; P = 0.31). In multivariable models, treatment group, HbA1c, and microvascular complications were not associated with risk of natural or surgical menopause. Each 10 unit/day increase in insulin dosage decreased risk of natural menopause (hazard ratio [HR] 0.91, 95% CI 0.75-0.98) and each kg/m(2) increase in BMI increased risk of surgical menopause (HR 1.08, 95% CI 1.00-1.16). CONCLUSIONS In the DCCT/EDIC, intensive versus conventional treatment group and HbA1c level were not associated with menopause risk. Greater insulin dose was associated with lower menopause risk.
authors.affiliation: Corresponding author: Catherine Kim, cathkim@umich.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Cowie
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Braffett
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Mary E
authors.initials: ME
authors.lastname: Larkin
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Gatcomb
authors.forename: Hunter B
authors.initials: HB
authors.lastname: Wessells
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D001783:Blood Flow Velocity / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000097:blood / Q000150:complications / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000097:blood / Q000150:complications / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008593:Menopause / Q000502:physiology; D008833:Microcirculation
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin