Does Earlier Menopause Mean A Higher Risk Of Diabetes?

Menopause is a major life transition for women, both psychologically and physiologically.  A number of changes occur in a woman's body that alters metabolism, unfortunately tipping the scales towards an increase in cardiovascular risk.  We know that an earlier age of menopause increases the risk of cardiovascular disease, and that a later age of menopause onset seems to be protective.

Whether earlier age of menopause increases the risk of developing type 2 diabetes has been somewhat controversial; a new study sheds additional light on this question.

The study, published in the journal Diabetologia, evaluated 3639 postmenopausal women from the population based Rotterdam study.  They followed these women for a median of 9.2 years, with the goal of assessing how the risk of developing type 2 diabetes may vary depending on the age of menopause.

They found that the risk for developing type 2 diabetes, compared to women with late menopause (at more than 55 years old), is:

• 3.7 times higher for women with premature menopause (at less than 40 years old)
• 2.4 times higher for women with early menopause (at 40-44 years old)
• 1.6 times higher for women with normal age of menopause (at 45-55 years old)

They found that for every year later that menopause occurred, the risk of developing diabetes decreased by 4%.

So why would the risk of diabetes go up with earlier menopause? With menopause comes a natural decrease in our reproductive hormones (estrogen, progesterone, and testosterone).   These changes promote a loss of muscle and an increase in fat, especially the visceral fat that sits around our abdomen and internal organs - this is the fat that has negative effects on our metabolism.  A loss of progesterone, and hot flashes from having lower estrogen levels, can impair sleep, which is a known risk factor for obesity and metabolic syndrome.  The emotional challenges of menopause may bring out an increase in emotional eating for some women, which can promote weight gain and increase diabetes risk as well.

Interestingly, this study looked at several reproductive hormone levels at the start of the study, and showed that earlier menopause was associated with an increase risk of diabetes, independent of these hormone levels, and also independent of body mass index at baseline or shared genetic factors.

The authors hypothesize that earlier menopause and type 2 diabetes may be a consequence of epigenetic changes, which are changes that alter the physical structure of our DNA.  Epigenetic changes can be caused by a number of factors, including poor diet, smoking, and many other environmental factors. 

Further studies need to be done looking at epigentic changes to determine if these may be responsible for the association between earlier menopause and diabetes risk. If epigentic changes are at play here, living well and healthily throughout life is more important than ever!

After menopause, we can combat cardiovascular and diabetes risk by:

• Keeping active - engage those muscles! This helps to combat the decrease in muscle mass. 
• Making healthy permanent lifestyle changes 
• Having good sleep hygiene
• Getting help from your doctor if you are struggling with menopausal symptoms.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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Dexcom G5 Continuous Glucose Monitor - New Glucose Monitoring Technologies Part 2

The traditional way of monitoring blood sugars is with finger pokes, but there are other newer technologies out there that make it not only easier to check, but provide more data as well.

Two new technologies have recently arrived in Canada: the Freestyle Libre (see last week's post on this), which is a poke free glucose monitor, and the Dexcom G5 continuous glucose monitor, which allows you to broadcast sugars wirelessly to family or caregivers.   This week, we’ll review the Dexcom G5.  

The Dexcom G5 is a continuous glucose monitor (CGM). This consists of a sensor that you apply to your abdomen (lasts 7 days) which measures glucose in the interstitial fluid that surrounds your cells under your skin, as an estimate of blood glucose levels.  There is a transmitter that fits onto the sensor (lasts 3 months), which transmits continuous sugar readings to the reader that comes with it.  It has alarms for low or high sugars.  It needs to be calibrated against finger poke readings every 12 hours, so while the CGM can decrease the number of finger pokes, it doesn’t eliminate them entirely.  

While CGMs are not new to Canada, the exciting new feature of this model is that it transmits glucose values not only to the reader, but also to smartphones, iPads, and some smart watches.  Also, the Dexcom5 has been approved in Canada and the USA for making treatment decisions (the previous model, the Dexcom G4, is not).  Though there have been reports of inaccuracies, the FDA concluded that 'the benefits of additional information gained from this device outweigh the inaccurate results, rates of change, and false negative and positive alarms and alerts'.  As far as the clinical trials go, the accuracy is reported to be within about 9% of actual blood sugar.  The cost is about $3100 per year (ouch!).

This can be a useful tool for parents (it’s approved down to age 2) or caregivers who want to keep an eye on their loved one’s sugars.  Also, CGMs with alarms have helped to keep many a patient of mine who have lost their ability to feel low blood sugars safer, waking them up at night when sugars are going low.   As for all of the interstitial glucose monitoring technologies - if in doubt about the glucose reading - check with a finger poke.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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