Menopause and diabetes

Improving Cardiovascular Clinical Competencies for the Menopausal Transition: A Focus on Cardiometabolic Health in Midlife

Cardiovascular disease (CVD) is the leading cause of death in women with an increase in risk after menopause. Over the past 20 years, longitudinal studies have helped differentiate the influence of chronological aging from ovarian aging on cardiovascular health. In addition to the pronounced sex hormone changes of the menopause transition (MT), the MT is also often accompanied by vasomotor symptoms, sleep problems, and mental health changes that impact women's cardiovascular health. The purpose of this invited review is to highlight the key changes that can alter CVD risk. Given the gaps in medical training, we also describe the need for specialized postgraduate curriculum in managing the MT with an aim to improve MT screening and management of CVD during this universal life stage. Finally, we propose a multidisciplinary approach led by experts in women's cardiovascular health and present an approach utilizing validated screening tools and CVD risk scores to discuss the candidacy of systemic menopause hormone therapy.

Association Between Nontraditional Lipid Profiles and the Risk of Type 2 Diabetes Mellitus in Chinese Adults With Hypertension: Findings From the China Hypertension Registry Study

The relationship between nontraditional lipid profiles and type 2 diabetes mellitus (T2DM) remains ambiguous within the hypertension population. The objective of this study is to examine the association between nontraditional lipid profiles and T2DM in Chinese adults with hypertension. The current investigation encompassed 13 728 participants with hypertension from the China Hypertension Registry Study. Logistic regression analysis and smooth curve fitting were employed to evaluate the association between nontraditional lipid profiles and T2DM. The prevalence of T2DM was found to be 17.8%. In the fully adjusted model, atherogenic index of plasma (AIP) exhibited the highest odds ratios (ORs) for T2DM (OR: 2.71, 95% confidence interval [CI]: 2.26-3.26). Conversely, the fully adjusted ORs (95% CI) for total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (Non-HDL-C) were 1.33 (1.25-1.41), 1.40 (1.29-1.51), and 1.41 (1.34-1.49), respectively. Additionally, the study demonstrated that AIP had a superior ability to identify T2DM. Subgroup analyses indicated that the relationship between AIP and Non-HDL-C with T2DM was more significant in the lighter weight population. In addition, the association of TC/HDL-C with LDL-C/HDL-C with T2DM was stronger in the lower homocysteine level population. Among the southern Chinese population with hypertension, all nontraditional lipid indices positively correlated with the risk of T2DM. Among these lipid indices, AIP exhibited superior discriminatory power in identifying T2DM compared to TC/HDL-C, LDL-C/HDL-C. Trial Registration: ChiCTR1800017274.

Menopause-Specific Quality of Life among Rural Women: A Community-based Cross-sectional Study in Kerala, India

Aim and Objectives

The health of women in the menopausal age is often ignored by most healthcare programs in countries like India. The aim of this study is to estimate the prevalence and pattern of menopause-specific quality of life (MENQOL) and associated factors of rural women in Kerala, India.

Materials and Methods

A cross-sectional community-based study was conducted among menopausal women in the Thiruvananthapuram district of Kerala using a multistage random sampling method. We collected details of basic sociodemographic and reproductive problems using a pretested semi-structured questionnaire. MENQOL questionnaire was used to measure the quality of life.

Results

We surveyed 250 women in the age group of 48-60 years. The average score of the overall quality of life was 12.4 ± 4.3. The mean MENQOL score was significantly poor for those with lower socioeconomic status (SES), those who had any morbidity, those who had bad perceived health status, and inactive women compared to their counterparts. The majority of women (92%) used self-care to alleviate their menopause symptoms. Women of lower SES, with any morbidity, poor perceived health status, and inactive, were more likely to report more symptoms in all domains (vasomotor, physical, and psychological). In addition, employed women reported more vasomotor and psychological symptoms compared to their counterparts.

Conclusion

Menopausal symptoms are common in the population studied, and self-care is the main strategy for alleviating these symptoms. It is important to educate women about common menopause symptoms and the importance of receiving proper medical care.

Threshold effect of atherogenic index of plasma on type 2 diabetes mellitus and modification by uric acid in normal-weight adults with hypertension

Background

The association between atherogenic index of plasma (AIP) and type 2 diabetes mellitus (T2DM) in normal-weight individuals with hypertension remains unclear. This study seeks to elucidate this relationship in normal-weight adults with hypertension.

Methods

This cross-sectional study included 8,258 normal-weight adults with hypertension from the China Hypertension Registry Study. The AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). The multivariate logistic regression, generalized additive model, smooth fitting curve, sensitivity analyses, two-part logistic regression, and subgroup analyses were conducted to detect the correlation between AIP and T2DM.

Results

The mean age of the study population was 64.89 ± 8.97 years, with an overall prevalence of T2DM of 15.55%. Multivariate logistic regression analyses indicated that there was a positive and independent relationship between AIP and T2DM (OR: 3.73; 95% CI: 2.82, 4.94). Threshold effect analysis identified a J-shaped association between AIP and T2DM, with an inflection point at 0. Additionally, an interaction between hyperuricemia and AIP was observed (P for interaction = 0.034).

Conclusions

In normal-weight adults with hypertension, there was a J-shaped association between AIP and T2DM, with an inflection point at 0. the correlation between AIP and T2DM was more pronounced in individuals with hyperuricemia compared to those with normal uric acid.

The dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist tirzepatide effects on body weight evolution, adiponectin, insulin and leptin levels in the combination of obesity, type 2 diabetes and menopause in mice

AIM

Tirzepatide (Tzp), a novel dual agonist glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1, is approved for treating insulin resistance and obesity, and menopausal women consuming a high-calorie diet are a target to study the Tzp effect. Therefore, we aimed to allometrically scale body weight (BW) in Tzp-treated obese diabetic menopausal mice.

MATERIALS AND METHODS

Three-month-old C57BL/6 female mice had bilateral ovariectomy (Ovx) or a sham procedure and for 12 weeks were fed a control diet or a high-fat and high sucrose diet (n = 120/each group [control (C), obese diabetic (Od), Ovx (O), sham (S), Tzp (T)]). Tzp was subcutaneously administered (10 nmol/kg) or vehicle once a day for an additional 4 weeks. The analysis considered log-transformed data and the allometric equation log y = log a + b log x.

RESULTS

Od and OdO showed more upward slopes than C and CO. In C, BW was non-allometric by T administration. Od and OdO showed slightly positive slopes (more prominent in OdO than Od). OdT and OdOT showed negative slopes, significant intercepts, and more robust Pearson coefficients than untreated ones. A potent drug effect was seen with BW allometric decline. Interactions between diet versus Ovx and diet versus Tzp affected weight gain. Diet versus Ovx versus Tzp affected food intake.

CONCLUSIONS

A model was developed to show three usual factors observed in mature women. Notably, Tzp improved the metabolism and weight loss of OdO mice. Tzp-treated mice showed negative allometric BW across treatment time, which is a quantitative assessment that allows better comparison between results.

The role of sex hormone binding globulin levels in the association of surgical and natural premature menopause with incident type 2 diabetes

OBJECTIVE

To examine associations of surgical and natural menopause before the age of 40 years with the risk of type 2 diabetes (T2D) in women.

METHODS

A total of 273,331 women from the United Kingdom were recruited between 2006 and 2010 in the UK Biobank (UKB) study, and 146,343 women aged 40 to 69 years who were postmenopausal at baseline were included in the analysis. Surgical menopause and natural premature menopause were defined as bilateral oophorectomy before the age of 40 and menopause before the age of 40 without oophorectomy, respectively. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between premature menopause and the incidence of T2D.

RESULTS

During a median follow-up of 10.4 years, 47 women with surgical premature menopause, 244 women with natural premature menopause, and 4724 women without premature menopause developed T2D. Compared with women without premature menopause, both surgical premature menopause (adjusted HR = 1.46, 95 % CI: 1.09-1.95; P = 0.01) and natural premature menopause (adjusted HR = 1.20, 95 % CI: 1.06-1.37; P < 0.01) were associated with higher risks of incident T2D in the multivariable-adjusted models. Additionally, we observed a significant interaction between levels of sex hormone binding globulin (SHBG) (Pinteraction < 0.01) and the effects of premature menopause on incident T2D. The association between premature menopause and T2D risk appeared to be stronger in women with higher SHBG levels. Furthermore, a joint association was detected between premature menopause and the genetic risk score (GRS) of T2D, with a higher score indicating a higher risk of developingT2D. The highest risk of T2D was observed with higher T2D GRS and surgical premature menopause (adjusted HR = 2.61, 95 % CI: 1.65-4.12; P < 0.01).

CONCLUSIONS

Surgical menopause and natural menopause before the age of 40 years were associated with an increased risk of T2D among postmenopausal women. The findings also suggest potential interactions of premature menopause with SHBG levels, with the association appearing to be stronger in higher SHBG levels, as well as a joint association between menopause status and genetic risk factors on T2D incidence.

Metabolic Syndrome and Survival Outcomes in Endometrial Cancer

Menopause, through attributable estrogen level decline and the corresponding increase in circulating androgens, significantly elevates a woman's risk for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular disease. Metabolic syndrome itself is a cluster of interconnected risk factors, and among them, central obesity is a well-established factor for the development of endometrial cancer (EC), the most common gynecologic malignancy. This research investigates the impact of metabolic syndrome on survival rates among patients with endometrial cancer. The goal is to assess whether having metabolic syndrome or its individual components influences disease-free survival (DFS), overall survival (OS), cancer-specific survival, and recurrence rates. Understanding this link is crucial for determining risk levels and could help tailor treatment approaches for better long-term outcomes in endometrial cancer care.

Menopausal Hormone Therapy in Women with Type 2 Diabetes Mellitus: An Updated Review

Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.

Caloric restriction prevents inflammation and insulin dysfunction in middle-aged ovariectomized mice

BACKGROUND

Loss of ovarian function is associated with increased visceral fat. In this study, we aimed to study the effects of caloric restriction (CR) on metabolism in ovariectomized mice.

METHODS AND RESULTS

Female, 8-12-month-old mice were divided into three groups: OVX (ovariectomized mice), OVXR (40% CR) and Sham. CR increased insulin sensitivity and glucose tolerance. AMPK phosphorylation was observed in the liver of OVXR mice. CR also increased hepatic cholesterol and triglyceride levels. The reductions in the level of TBARS in the serum and liver and of H2O2 in the liver of OVXR mice suggested alterations in the redox state of the liver. Although expression of catalase protein was reduced by CR, expression of superoxide dismutase was not altered by CR. Although interleukin IL-6 and IL-10 levels in OVXR mice were similar to those in Sham mice, macrophage infiltration was reduced in OVXR mice. OVXR mice had increased sirtuin1 levels and decreased sirtuin3 levels in the liver.

CONCLUSIONS

In conclusion, CR improved the condition of ovariectomized mice by reducing adiposity and increasing insulin sensitivity and glucose tolerance through a mechanism that may involve AMPK.