Association of hyperandrogenemia and hyperestrogenemia with type 2 diabetes in Hispanic postmenopausal women

Department of Medicine, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
Diabetes Care (Impact Factor: 8.42). 01/2000; 23(1):74-9. DOI: 10.2337/diacare.23.1.74
Source: PubMed


Accumulating evidence suggests that hyperandrogenemia may be a risk factor for coronary heart disease (CHD) in women. The present study was carried out to test the hypothesis that hyperandrogenemia is associated with type 2 diabetes in women and thus may contribute to the increased risk of CHD in women with type 2 diabetes.
Sex hormones, sex hormone-binding globulin (SHBG), and risk factors for CHD were measured in 20 postmenopausal women with type 2 diabetes and in 29 control subjects. All of the diabetic and control subjects were Hispanic women aged >55 years who were not taking hormone replacement therapy lipid-lowering drugs, or insulin and who were otherwise randomly chosen from a cohort of stroke-free subjects from the Northern Manhattan Stroke Study
Mean age, BMI, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, blood pressure, and smoking were not significantly different between cases and control subjects, but waist-to-hip ratio (WHR) was significantly higher in the diabetic subjects (P = 0.01). The mean levels of free testosterone (FT) (P = 0.01), dehydroepiandrosterone sulfate (P<0.04), and estradiol (P = 0.01) (controlled for WHR) were significantly higher in the diabetic subjects; with the statistical outliers removed, the testosterone (P = 0.05) and androstenedione (P = 0.002) levels (controlled for WHR) were also significantly higher in the diabetic subjects. The mean levels of estrone, cortisol, and SHBG were not significantly different. The results were similar in the 10 diabetic subjects treated with diet only Significant positive correlations (controlled for age and BMI) were observed between FT or testosterone and cholesterol, LDL cholesterol, and blood pressure.
Postmenopausal Hispanic women with type 2 diabetes had both hyperandrogenemia and hyperestrogenemia, and testosterone or FT correlated positively with risk factors for CHD. Hyperandrogenemia may be a link between diabetes and CHD in women.

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    • "It could be hypothesized that, after an initial effect from cigarette smoking causing insulin resistance, an adverse effect on the beta cell becomes predominant after decades of exposure. In current smokers, smoking-related responses promoting insulin resistance are the androgenic state and increased secretion of antiinsulin hormones, including adrenaline and growth hormone release, as well as elevated fatty acids (Wild et al., 1990; Hautanen & Adlercreutz, 1993; Hellerstein et al., 1994; Phillips et al., 2000). Smoking-related responses that may counter insulin resistance, in normoglycaemic individuals, include elevated skeletal muscle blood flow, lower body weight and caloric intake, and enhanced thermogenesis (Weber et al., 1989). "

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    ABSTRACT: In healthy women, menopause symptoms have been associated with decreased quality of life, limitations in physical functioning and perceived declines in health status. Most menopause research is limited to the study of healthy women and little is known as to how menopause symptoms manifest themselves in women with type 2 diabetes. This study employed a comparative group design to examine the menopause symptom experience of three groups of women veterans receiving care in the Veteran Affairs Healthcare system: women without diabetes (n = 90), women with controlled diabetes (hemoglobin A1c [HbA1c] < 7%; n = 135) and women with poorly controlled diabetes (HbA1c > 7%; n = 102). Participants were recruited from an ethnically diverse postmenopausal sample (n = 536) who responded to a national mailed survey (n = 900) and consented to clinical data access. As a group, the women were obese, of low income with more than one chronic illness. On average, menopause symptom prevalence rates were higher compared to those observed in previous community-based investigations of ethnically diverse non-veteran cohorts. However, despite higher BMI and increased disease-related co-morbidities, diabetic participants experienced menopause at the same age and reported similar menopause symptoms as the non-diabetic cohort. Among respondents with diabetes, glucose control was an important clinical correlate of menopause symptom severity, independent of obesity, surgical menopause, and non-European ethnicity. With the exception of vasomotor symptoms, women veterans with poor glucose control demonstrated higher menopause symptom severity scores (total score, psychological and somatic factor scores) than their controlled peers of comparable body size, years postmenopause and psychological status. Further, both menopause symptom severity and glucose control were significant correlates of perceived physical health in the diabetic cohort. These findings substantiate the importance of addressing menopause health issues in the clinical management of women veterans with diabetes using services in the VA healthcare system. For this group already in poor health, interventions targeting glucose control may also improve their menopause symptom experience. Future studies are warranted to better understand the relationship between military service and the menopause experience of women veterans, and confirm these findings in non-veteran diabetic populations. Ph.D. Nursing University of Michigan, Horace H. Rackham School of Graduate Studies
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