Type 1 Diabetes Leads to Changes in Glucose Regulation in Postmenopausal Women

Roughly 2 in 3 women with type 1 diabetes (T1D) experience changes in glucose regulation after menopause, which are associated with the severity of reported menopausal symptoms.1

In 2021, at the time of this study, the global incidence of T1D had reached 8.4 million, with missing prevalent cases estimated at 3.7 million. A projection out to 2040 predicted an increase of 60-107%, with prevalent cases rising to 13.7-17.4 million. This rapid increase underscores the importance of completely understanding the disease and how it affects particular demographics, which have remained understudied.2

“It has been established that changes in glucose regulation occur within the menstrual cycle and in pregnancy,” Esther Speksnijder, PhD candidate in the department of endocrinology and metabolism, Amsterdam UMC, and colleagues. “However, the impact of menopause on glycemic management in women with type 1 diabetes remains to be explored.”1

Investigators conducted a cross-sectional survey of postmenopausal women with T1D in the Netherlands. The final version contained 6 sections:

• Demographic characteristics (14 items)
• Menstruation and bleeding (5 items)
• Perceived changes in glucose regulation (13 items)
• The Greene climacteric scale before and after menopause (2x21 items) and 1 question about hormone therapy
• The ultra-short Munich chronotype questionnaire (7 items)
• The Pittsburgh Sleep Quality Index (15 items)1

The estimated completion time was roughly 20 minutes. The questionnaire was completed in chronological order; each section needed to be completed fully before progressing to the next. The questionnaires were distributed through advertisements in 41 hospitals in the Netherlands and on 3 online platforms. Questionnaires were filled in anonymously and completed online in an electronic database.1

Postmenopausal women (≥1 year of amenorrhea) with T1D aged 45-65 years were included in the study. Women taking postmenopausal hormone therapy were allowed to participate. Participants reported their age at the final menstrual period, age at diabetes diagnosis, and whether they had undergone an ovariectomy or hysterectomy. Women with <1 year of amenorrhea and those with primary amenorrhea, premenopausal hysterectomy, or a postmenopausal diabetes diagnosis were excluded.1

The team noted the primary outcome as perceived change in glucose regulation, which was assessed using a 5-point Likert scale. Participants could indicate to what extent they perceived changes after their final menstrual period compared to their first based on the following categories: no change, little change, moderate change, large change, or huge change. Participants then indicated whether their glucose levels after the final menstrual period were much lower, lower, similar, higher, or much higher.1

Secondary outcomes included perceived change in fasting glucose levels, perceived change in HbA1c levels, and perceived change in insulin dosage and time in range. Sleep quality and chronotype were assessed with the Pittsburgh Sleep Quality Index (PSQI) and the ultra-short Munich chronotype questionnaire, respectively.1

A total of 374 patients initiated the questionnaire; 159 of these were eligible for inclusion. The completion rate of these questionnaires was 81% (n = 129). Given the smaller sample size compared to the intended 374, Cochran’s sample size formula was used to calculate the actual margin of error, which was 8%.1

Roughly 67.4% of patients observed moderate to severe changes in glucose regulation following menopause; 41.9% reported increased blood glucose levels, 19.6% reported lower glucose levels, and 38.5% reported no change. A collective 55% of participants experienced more glucose level fluctuations, and 18.1% experienced fewer fluctuations. 38.5% experienced more hypoglycemic events and 28% experienced fewer.1

Additionally, reported menopausal symptoms were more severe after the final menstrual period compared with before the first (GCS scores 18.8 +/- 9.9 vs 11.7 +/- 8.3 [means +/- standard deviation (SD)]; P <.001). An increase in GCS scores was also associated with an increase in odds of perceiving glucose regulation changes (adjusted odds ratio [OR], 1.04; 95% CI, 1.01-1.08; P = .014; unadjusted OR 1.04; 95% CI, 1.01-1.07; P = .015).1

“These results highlight the need for awareness among medical professionals treating women with type 1 diabetes, as women undergoing the menopausal transition may experience changes in glucose metabolism that may impact their treatment objectives,” wrote Speksnijder and colleagues. “Prospective studies are needed to assess whether these perceived changes are mirrored by laboratory-measured glycemic outcomes.”1

References

1. Speksnijder, E.M., Simsek, S., Bisschop, P.H. et al. Perceived blood glucose regulation after menopause: a cross-sectional survey in women with type 1 diabetes in the Netherlands. Diabetologia (2025). https://doi.org/10.1007/s00125-025-06518-z

2. Gregory GA, Robinson TIG, Linklater SE, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022;10(10):741-760. doi:10.1016/S2213-8587(22)00218-2