Menopause Not Linked to Diabetes Risk in High-Risk Women

From Medscape Medical News

Laurie Barclay, MD

August 2, 2011 — Natural menopause is not linked to diabetes risk in high-risk women, according to the results of an observational study within a randomized controlled trial reported in the August issue of Menopause.
"In our study, menopause had no additional effect on risk for diabetes," said lead author Catherine Kim, MD, MPH, an associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System in Ann Arbor, in a news release.
"Menopause is one of many small steps in aging and it doesn't mean women's health will be worse after going through this transition.... Physicians can be empowered to tell women that lifestyle changes can be very effective, and that menopause does not mean that they have a higher risk of diabetes."

The goals of this study were to evaluate the association between menopause status and diabetes risk in women with glucose intolerance and to assess whether menopausal status would affect the response to diabetes prevention interventions.
Participants were enrolled in the Diabetes Prevention Program, a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose-intolerant adults.
These participants included 708 premenopausal women, 328 women in natural postmenopause, and 201 women who had undergone bilateral oophorectomy.
Cox proportional hazard models were used to examine associations between menopause and diabetes risk, after adjustment for demographic factors including age and race/ethnicity, family history of diabetes, history of gestational diabetes mellitus, waist circumference, insulin resistance, and corrected insulin response. After stratification by menopausal status and use of hormone therapy, similar models were constructed.
Natural menopause or bilateral oophorectomy was not associated with diabetes risk, after adjustment for age.
Among women randomly assigned to the lifestyle intervention, those with bilateral oophorectomy had a lower adjusted hazard for diabetes (hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.04 - 0.94). However, there were insufficient observations to determine if this trend was independent of hormone therapy use. No significant differences were observed in the metformin group (HR, 1.29; 95% CI, 0.63 - 2.64) or placebo group (HR, 1.37; 95% CI, 0.74 - 2.55).
"Among women at high risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions," the study authors write. "In the lifestyle intervention, bilateral oophorectomy was associated with a decreased diabetes risk."
Limitations of this study include observational design with possible residual confounding; inability to exclude the possibility that natural menopause is associated with altered glucose tolerance among women who have normal glucose levels before treatment; and inability to assess the effects of hormone therapy among women in surgical menopause in the lifestyle group, because of the lack of diabetes cases in that group.
"The present report has clinical and public health relevance, showing that natural menopause does not modify the impact of diabetes prevention interventions among women at high risk for diabetes," the study authors conclude. "Although we did not find a significant association between natural menopause and diabetes risk, our study cannot completely rule out a more modest association. Bilateral oophorectomy may have different effects on response to lifestyle interventions than natural menopause, but the role of HT [hormone therapy] needs to be assessed."

Menopause. 2011;18:857-868.