Skip to main content Accessibility help
×
Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T18:01:32.588Z Has data issue: false hasContentIssue false

15 - Diabetes in mid-life women

from Part III - Disease prevention

Published online by Cambridge University Press:  21 August 2009

Phillippa Miranda
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA
Diana McNeill
Affiliation:
Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA
Jo Ann Rosenfeld
Affiliation:
The Johns Hopkins University
Get access

Summary

Case: a 51-year-old woman who has had type 2 diabetes for five years is managed with metformin, diet, and exercise. She notes worsening hyperglycemia, but attention to diet and exercise does not seem to improve glycemic control as it has in the past. She mentions to her physician that she has missed her last two menstrual periods and that she seems to be a “bit more edgy.” She wonders whether there is a correlation between her worsening diabetes control and her menstrual changes.

Definitions

Diabetes mellitus refers to a group of common metabolic disorders characterized by hyperglycemia. Diabetes may be type 1 (juvenile-onset or insulin-dependent diabetes mellitus – IDDM), type 2 (adult-onset or non-insulin-dependent diabetes mellitus – NIDDM), or gestational (during pregnancy). In type 1 diabetes, hyperglycemia is caused by an absolute deficiency of insulin secretion. In type 2 diabetes, hyperglycemia is caused by a combination of insulin resistance and inadequate compensatory insulin secretory response, with a relative, not absolute, insulin deficiency.

The most common type of diabetes in mid life is type 2 diabetes, often caused by a combination of inherited and environmental factors and lifestyle choices. Type 2 diabetes is associated with numerous metabolic abnormalities, including reduced insulin secretion, increased hepatic glucose production, decreased glucose uptake by muscle and adipose tissue, and dyslipidemia. These metabolic abnormalities underlie the complications of diabetes, including heart attack, stroke, blindness, end-stage renal disease, and lower-extremity amputation.

Type
Chapter
Information
Women's Health in Mid-Life
A Primary Care Guide
, pp. 253 - 272
Publisher: Cambridge University Press
Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Diabetes Association: www.diabetes.org
The Endocrine Society: www.endo-society.org
Information on diabetes and menopause: www.mayoclinic.com
King, H., Aubert, R. E. and Herman, W. H.Global burden of diabetes, 1995–2025. Diabet. Care 1998; 21:1414–31CrossRefGoogle Scholar
Harris, M. I., Flegal, K. M., Cowie, C. C., et al.Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. Diabet. Care 1998; 21:518–24CrossRefGoogle ScholarPubMed
Gu, K., Cowie, C. C. and Harris, M. I.Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabet. Care 1998; 21:1138–45CrossRefGoogle Scholar
American Diabetes Association. Screening for diabetes. Diabet. Care 2002; 25(supp 1):S21–4CrossRef
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabet. Care 2002; 25(supp 1):S5–20CrossRef
World Health Organization. Diabetes Mellitus: Report of a WHO Study Group. Geneva: World Health Organization; 1985
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabet. Care 2002; 25(supp 1):S33–49CrossRef
American Diabetes Association. Tests of glycemia in diabetes. Diabet. Care 2002; 25(supp 1):S97–9CrossRef
American Diabetes Association and NIDDK. The prevention or delay of type 2 diabetes. Diabet. Care 2002; 25:742–9CrossRef
Colditz, G. A., Willett, W. C., Rotnitzky, A. and Manson, J. E.Weight gain as a risk factor for clinical diabetes mellitus in women. Ann. Intern. Med. 1995; 122:481–6CrossRefGoogle ScholarPubMed
Folsom, A. R., Kushi, L. H. and Hong, C. P.Physical activity and incident diabetes mellitus in postmenopausal women. Am. J. Publ. Health 2000; 90:134–8Google ScholarPubMed
Knowler, W. C., Barret-Connor, E., Fowler, S. E., et al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 2002; 346:393–403Google ScholarPubMed
Poirier, L. and Coburn, K. Women and Diabetes. Alexandria, VA: American Diabetes Association; 1997
Samaras, K., Hayward, C., Sullivan, D., Kelly, R. and Campbell, L.Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, lipid metabolism, and vascular factors in type 2 diabetes. Diabet. Care. 1999; 22:1401–7CrossRefGoogle ScholarPubMed
Matthews, K. A., Meilahn, E., Kuller, L. H., et al.Menopause and risk factors for coronary heart disease. N. Engl. J. Med. 1989; 321:641–6CrossRefGoogle ScholarPubMed
The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Intervention (PEPI) trial. J. Am. Med. Assoc. 1995; 273:199–208CrossRef
Andersson, B., Mattsson, L. A., Hahn, I., et al.Estrogen replacement therapy decreases hyperandrogenicity and improves glucose homeostasis and plasma lipids in postmenopausal women with noninsulin-dependent diabetes. J. Clin. Endocrinol. Metab. 1997; 82:638–43Google ScholarPubMed
Stratton, I. M., Adler, A. I., Neil, H. A., et al.Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br. Med. J. 2000; 321:405–12CrossRefGoogle ScholarPubMed
Ferrara, A., Karter, A., Ackerson, L., Liu, J. and Selby, J.Hormone replacement therapy is associated with better glycaemic control in women with type 2 diabetes. Diabet. Care 2001; 24:1144–50CrossRefGoogle Scholar
Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. J. Am. Med. Assoc. 2002; 288:321–23CrossRef
Grady, D. and the HERS research group. Cardiovascular disease outcomes during 6.8 years of hormone therapy. J. Am. Med. Assoc. 2002; 288:49–57CrossRefGoogle ScholarPubMed
Osteoporosis prevention, diagnosis, and therapy. NIHConsens. Statement 2000; 17:1–36
Surwit, R., Tilburg, M., Zucker, N., et al.Stress management improves long-term glycemic control in type 2 diabetes. Diabet. Care 2002; 25:30–34CrossRefGoogle ScholarPubMed
Dorman, J., Steenkiste, A., Foley, T., et al.Menopause in type 1 diabetic women: is it premature?Diabetes 2001; 50:1857–62CrossRefGoogle ScholarPubMed
American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabet. Care 2002; 25(supp 1):S50–60CrossRef
American Diabetes Association. Diabetes mellitus and exercise. Diabet. Care 2002; 25(supp 1):S64–8CrossRef
Devlin, J. T. and Ruderman, N. The Health Professional's Guide to Diabetes and Exercise. Alexandria VA: American Diabetes Association; 1995
American Diabetes Association. Implications of the Diabetes Control and Complications Trial. Diabet. Care 2002; 25(supp 1):S25–7CrossRef
Feinglos, M. N. and Bethel, M. A.Treatment of type 2 diabetes mellitus. Med. Clin. North Am. 1998; 82:757–90CrossRefGoogle ScholarPubMed
Inzucchi, S. E.Oral antihyperglycemic therapy for type 2 diabetes. Scientific review. J. Am. Med. Assoc. 2002; 287:360–72CrossRefGoogle ScholarPubMed
Diabetes Control and Complications Trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993; 329:977–86CrossRef
UK Prospective Diabetes Study Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–53CrossRef
Poirier, L. and Coburn, K. Women and Diabetes. Alexandria, VA: American Diabetes Association; 1997
Howard, B., Cowan, L., Go, O., et al.Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. Diabet. Care 1998; 21:1258–65.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Diabetes in mid-life women
    • By Phillippa Miranda, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA, Diana McNeill, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University
  • Book: Women's Health in Mid-Life
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545672.015
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Diabetes in mid-life women
    • By Phillippa Miranda, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA, Diana McNeill, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University
  • Book: Women's Health in Mid-Life
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545672.015
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Diabetes in mid-life women
    • By Phillippa Miranda, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA, Diana McNeill, Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, NC, USA
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University
  • Book: Women's Health in Mid-Life
  • Online publication: 21 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545672.015
Available formats
×