I read this article that’s been circulating the Internet over the past few days entitled “Men With Type 1 Diabetes Are Better at Blood Sugar Control Than Women” and I found myself thinking that maybe this isn’t such a surprise. Although the media’s inflammatory word choice for the article title seems to imply “men do it better”, the actual study title, “Sex differences in glycaemic control among people with type 1 diabetes” and study content lean towards biological differences.
Why am I so interested in this study? As a woman I truly believe that hormone balance is a key issue in my BG control. In fact I’m sure of it because I’ve tested my theories in my own private lab (i.e. my body). When my hormones are balanced, I’m proactive with my BG control, fine-tuning my basal rates and having reasonably good predictability of bolus outcomes. Whereas, when my hormones are not balanced, suddenly my fine-tuned basal rates and boluses don’t work as well as they used to, my insulin resistance goes up, and I’m constantly chasing highs and treating lows. Even PWDs who don’t have extra complications beyond a normal monthly cycle often mention having higher BGs the week prior to their periods. Are there type 1 diabetes issues related specifically to women that we should be aware of?
I decided to look further into it. First, I wanted to actually see the real study this media story was based on. It took some digging but I found the Abstract and Poster submitted by Dr. Wild to the European Association for the Study of Diabetes (EASD). The study divided individuals into 3 age groups, under 15, 15-24, and over 24. The final conclusion states: “In this cross-sectional analysis of international data, there was a small difference in glycaemic control in males and females in the youngest age group, however control of type 1 diabetes was poorer in women than men in the two older strata. This association did not appear to be confounded by age or duration of diabetes.” Seems reasonable to me that the youngest strata is the least different from males, in that most of that age group hasn’t started a monthly cycle yet. (Yes, I’m sure there are also many other biological reasons to consider.)
Secondly, I looked up information about Dr. Wild and found an interesting recent article she authored related to female cycles, diabetes, and diabetes-disease correlations, entitled “Diabetes in women − A life-course approach”. I’m hoping this means more future studies will be conducted related to PWDs and hormones. The lack of information on this has been frustrating for me, to say the least. A few specific women’s health correlations to diabetes from the article are below. While most of the correlations are negative, I’m certainly not trying to be Ms. Diabetes Doomsday. But I do feel that as PWDs, these are women’s health correlations that we should be aware of. If for no other reason, than that our local OBGYN, Endo, or Primary Physician may not be (mine weren’t aware of quite a few).
And after all, let’s call a spade a spade; women do tend to be more complicated ^_^
- T1 diabetes appears to be associated with a delay in menarche and with menstrual irregularities.
- Diabetes is associated with less frequent ovulation and the ability to conceive was about 75% of that of a non-diabetic.
- There is evidence to suggest that women with diabetes undergo earlier menopause than women without diabetes.
- Effect of pregnancy on pre-existing diabetes: Pregnancy leads to increased insulin resistance and is associated with a higher frequency of hypoglycaemic episodes (and reduced hypoglycaemia awareness) in women with type 1 diabetes.
- If you have gestational diabetes, you are at increased risk for developing subsequent T2 diabetes.
- Odds of developing T2 diabetes were 4-fold higher for women with PCOS than those without.
- Post Menopausal Hormone Replacement Therapy (HRT) in PWDs: Given the risks of both diabetes and the menopause, each case needs to be evaluated on its individual merits. Do the vasomotor and osteoporosis beneﬁts outweigh the risks of endometrial or breast cancer? A large meta-analysis found that women with diabetes taking HRT had signiﬁcantly reduced insulin resistance (12.9%, 95%CI 19.8–51.7%), reduced fasting glucose (11.5%, 95%CI 5.1–18.0%) and reduced fasting insulin (20.2%, 95%CI 4.2–36.3%), compared to those taking placebo or no treatment.
- HRT in PWOD’s: A meta-analysis of 107 randomized controlled trials found a 30% reduction in the incidence of diabetes in women taking HRT vs no treatment or placebo. They also found non-diabetic users had signiﬁcantly lower abdominal adiposity and waist circumference and more positive lipid proﬁles than non-users. Again individual women need to weigh the risks and beneﬁts of HRT.
- A number of studies have repeatedly conﬁrmed osteoporosis as a complication of T1 diabetes.
- Women with T1 diabetes were 12.25 times more likely to report an incident hip fracture than women without diabetes.
- A number of researchers have looked at the relationship between diabetes and endometrial cancer and consistently found an increased risk of endometrial cancer amongst women with T2 diabetes. No association has been shown for T1 diabetes.
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