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Influence of menopause on diabetes and diabetes risk

Abstract

Many postmenopausal women live with diabetes mellitus; however, little information is available about how the changes that occur around the time of menopause might uniquely affect management of diabetes mellitus in this population. Although the weight gain that commonly occurs during the menopausal transition is largely attributable to aging rather than the transition itself, changes in body composition have been independently associated with menopausal status. These changes in body composition have, in turn, been associated with alterations in insulin sensitivity and glucose metabolism in postmenopausal women. Hormone therapy seems to have neutral or beneficial effects on the adverse changes in body composition associated with menopause. Whether menopausal status independently influences diabetes risk remains controversial. Nevertheless, consistent findings from large clinical trials suggest that postmenopausal hormone therapy decreases the risk of developing diabetes mellitus. Similarly, many studies suggest that postmenopausal hormone therapy has neutral or beneficial effects on glycemic control among women already diagnosed as having diabetes mellitus. Future studies are needed to elucidate the mechanisms that underlie these relationships and to determine how these observations should influence recommendations for the care of postmenopausal women with diabetes mellitus.

Key Points

  • Menopause has been associated with changes in body composition, which in turn have been linked to adverse changes in insulin sensitivity and glucose metabolism

  • Hormone therapy seems to have neutral or beneficial effects on the adverse changes in body composition associated with menopause

  • Whether menopausal status independently influences diabetes risk remains controversial

  • Some evidence suggests that postmenopausal hormone therapy decreases the risk of developing diabetes mellitus

  • Postmenopausal hormone therapy has neutral or beneficial effects on glycemic control among women already diagnosed as having diabetes mellitus

  • Further studies are needed to determine how these observations will affect clinical practice; in the meantime, postmenopausal hormone therapy should not be prescribed for the purpose of diabetes prevention

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Acknowledgements

The authors thank Zainab Abdul-Rahim (Brigham and Women's Hospital, Boston, MA, USA) for assistance with manuscript preparation.

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Correspondence to Ellen W. Seely.

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Szmuilowicz, E., Stuenkel, C. & Seely, E. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol 5, 553–558 (2009). https://doi.org/10.1038/nrendo.2009.166

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