Perceived blood glucose regulation after menopause: a cross-sectional survey in women with type 1 diabetes in the Netherlands

AIMS/HYPOTHESIS: Women with type 1 diabetes experience changes in insulin requirements in pregnancy and throughout the menstrual cycle. It remains to be explored whether women with type 1 diabetes perceive changes in glucose regulation during and after the menopausal transition, another period of marked hormonal change in a woman's life.

METHODS: We conducted a cross-sectional survey to investigate whether women with type 1 diabetes perceive changes in glucose regulation after their final menstrual period. The online questionnaires were distributed through advertisements in hospitals and through online platforms for people living with type 1 diabetes in the Netherlands. Postmenopausal women (≥1 year of amenorrhoea) with type 1 diabetes, aged 45-65 years, were included. Participants with primary amenorrhoea, premenopausal hysterectomy or a postmenopausal diabetes diagnosis were excluded from the study. The primary outcome was the extent to which participants perceived changes in their glucose regulation following their final menstrual period, assessed using a five-point Likert scale. Menopausal symptom severity was estimated using the Greene climacteric scale (GCS).

RESULTS: Questionnaires from a total of 159 women were eligible for inclusion. Participants had a mean age of 54.9 years (SD 3.8), a mean diabetes duration of 30.3 years (SD 12.8), and had their final menstrual period at a mean age of 50.1 years (SD 5.0). Overall, 67.4% of participants reported moderate to severe postmenopausal changes in glucose regulation. Increased blood glucose levels were perceived by 41.9% of participants, 19.6% perceived lower glucose levels and 38.5% perceived no change in blood glucose levels. For fluctuations in glucose levels, 55.0% experienced more fluctuations and 18.1% experienced less fluctuation. More hyperglycaemic events were experienced by 61.6% of participants, while 38.5% experienced more hypoglycaemic events and 28.0% experienced fewer hypoglycaemic events. Reported menopausal symptoms were more severe after the final menstrual period compared with before the final menstrual period (mean GCS score ± SD: 18.8±9.9 vs 11.7±8.3, p<0.001). An increase in postmenopausal symptom severity score was associated with an increase in the odds of perceiving postmenopausal changes in glucose regulation, with an adjusted OR of 1.04 (95% CI 1.01, 1.08; p=0.014). A total of 57.2% of participants had a global Pittsburgh sleep quality index (PSQI) score >5, indicating poor sleep quality. Poor sleep quality was not associated with perceived glycaemic changes after menopause (global PSQI >5) (adjusted OR 1.10; 95% CI 0.58, 2.08; p=0.731).

CONCLUSIONS/INTERPRETATION: Approximately two-thirds of women with type 1 diabetes perceive changes in their glucose regulation after menopause, including subjective changes in the number of hyperglycaemic and hypoglycaemic events. Changes in perceived glucose regulation were associated with the severity of reported menopausal symptoms. These results highlight the need for awareness among medical professionals treating women with type 1 diabetes, as those going through the menopausal transition may experience changes in glucose metabolism, which can affect their diabetes management.

DATA AVAILABILITY: The data that support the findings of this study are available on request from DataVerseNL with the identifier https://doi.org/10.34894/84QJOO .