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Age at Natural Menopause and Its Determinants in Women with Type 1 Diabetes

Yi, Yan (2021) Age at Natural Menopause and Its Determinants in Women with Type 1 Diabetes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Earlier age at menopause is associated with increased risks of cardiovascular disease, osteoporosis, fracture, and mortality. Existing findings regarding whether women with type 1 diabetes experience earlier menopause than women without diabetes are conflicting. Moreover, data on determinants of an earlier age at menopause in women with type 1 diabetes are scarce and to date, no study has assessed the impact of the timing of developing diabetes complications on age at menopause in these women. This dissertation aimed to fill these research gaps by utilizing data from two well-characterized cohorts.
In paper 1, we demonstrated that women with type 1 diabetes have a shorter reproductive period compared with non-diabetic women, exhibiting delayed menarche and earlier natural menopause. These findings were restricted to women who were diagnosed with type 1 diabetes before reaching menarche. In paper 2, we observed that higher average levels of insulin dose and albumin excretion rate over time were significantly associated with an earlier age at natural menopause in type 1 diabetes after multivariable adjustments, including for HbA1c. In paper 3, we found that menopause appears to occur 2.06 years earlier in women with microalbuminuria diagnosed before age 30 compared with women without microalbuminuria. A similar pattern was observed for overt nephropathy and coronary artery disease, although results did not reach statistical significance.
Given the enormous impact on health associated with early menopause, our comprehensive work has significant public health and clinical implications as it 1) identified the subgroup of women with type 1 diabetes who have a high likelihood of experiencing early age at natural menopause so that efforts to unearth the biologic rationale and target potential prevention practices would be better focused, 2) raised significant questions relating to a potentially deleterious effect of high exogenous insulin doses, in addition to that of kidney disease, which may constitute a useful source in clinical reproductive counseling for women with type 1 diabetes, and 3) suggested that premature ovarian aging may be one phenotype of diabetes vascular complications which increased awareness of diabetes complications and further emphasized the importance of preventing vascular damage in type 1 diabetes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Yi, Yanyay65@pitt.eduyay65
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCostacou,
Committee MemberOrchard,
Committee MemberEl Khoudary,
Committee MemberBuchanich,
Committee MemberMiller,
Date: 8 February 2021
Date Type: Publication
Defense Date: 21 October 2020
Approval Date: 8 February 2021
Submission Date: 20 November 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 148
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: type 1 diabetes; age at natural menopause; insulin dose; diabetes complications
Date Deposited: 08 Feb 2021 17:01
Last Modified: 08 Feb 2023 06:15


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