Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
Menopause. 2011 Aug;18(8):857-68. doi: 10.1097/gme.0b013e31820f62d0.
The study objectives were to examine the association between menopause status and diabetes risk among women with glucose intolerance and to determine if menopause status modifies response to diabetes prevention interventions.
The study population included women in premenopause (n = 708), women in natural postmenopause (n = 328), and women with bilateral oophorectomy (n = 201) in the Diabetes Prevention Program, a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose-intolerant adults. Associations between menopause and diabetes risk were evaluated using Cox proportional hazard models that adjusted for demographic variables (age, race/ethnicity, family history of diabetes, history of gestational diabetes mellitus), waist circumference, insulin resistance, and corrected insulin response. Similar models were constructed after stratification by menopause type and hormone therapy use.
After adjustment for age, there was no association between natural menopause or bilateral oophorectomy and diabetes risk. Differences by study arm were observed in women who reported bilateral oophorectomy. In the lifestyle arm, women with bilateral oophorectomy had a lower adjusted hazard for diabetes (hazard ratio [HR], 0.19; 95% CI, 0.04-0.94), although observations were too few to determine if this was independent of hormone therapy use. No significant differences were seen in the metformin (HR, 1.29; 95% CI, 0.63-2.64) or placebo arms (HR, 1.37; 95% CI, 0.74-2.55).
Among women at high risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions. In the lifestyle intervention, bilateral oophorectomy was associated with a decreased diabetes risk.
本研究旨在探讨葡萄糖耐量异常女性的绝经状态与糖尿病风险之间的关系，并确定绝经状态是否会影响糖尿病预防干预的效果。
本研究人群包括处于绝经前期（n=708）、自然绝经后（n=328）和双侧卵巢切除术后（n=201）的女性，她们均参加了糖尿病预防计划（Diabetes Prevention Program），这是一项针对葡萄糖耐量异常成年人的生活方式干预和二甲双胍随机安慰剂对照试验。使用 Cox 比例风险模型评估绝经与糖尿病风险之间的关联，该模型调整了人口统计学变量（年龄、种族/族裔、糖尿病家族史、妊娠糖尿病史）、腰围、胰岛素抵抗和校正胰岛素反应。在按绝经类型和激素治疗使用分层后，构建了类似的模型。
在校正年龄后，自然绝经或双侧卵巢切除与糖尿病风险之间没有关联。在报告双侧卵巢切除的女性中，研究组之间存在差异。在生活方式组中，双侧卵巢切除的女性发生糖尿病的调整风险较低（风险比 [HR]，0.19；95%置信区间 [CI]，0.04-0.94），尽管观察到的病例数太少，无法确定这是否独立于激素治疗的使用。在二甲双胍（HR，1.29；95%CI，0.63-2.64）或安慰剂组（HR，1.37；95%CI，0.74-2.55）中未见显著差异。
在糖尿病高危女性中，自然绝经与糖尿病风险无关，也不会影响糖尿病预防干预的效果。在生活方式干预中，双侧卵巢切除与糖尿病风险降低有关。
