Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan.
Health Information and Epidemiology Laboratory of Chang Gung, Memorial Hospital Chiayi Branch, Chiayi County, Taiwan.
Diabetes Res Clin Pract. 2018 Sep;143:151-158. doi: 10.1016/j.diabres.2018.07.010. Epub 2018 Jul 9.
The aim of this study was to assess the fertility rate in Taiwanese women before and after a diagnosis of type 1 diabetes. The potential risk factors which may have influenced fertility were also investigated.
We conducted this retrospective, nationwide, population-based, matched cohort study using data from the Taiwan National Health Insurance Research Database. The diabetic group (n = 1191) included women with type 1 diabetes aged between 16 and 30 years in 2000. The non-diabetic group (n = 4764) was matched by sex, gender, income, and urbanization. The endpoints, including live births, abortions, and fertility, were tracked until the end of 2013. Poisson regression was used to assess incidence rate ratios (IRRs). We also analyzed the influence of autoimmune thyroid disease, diabetic ketoacidosis, diabetic complications, and daily insulin dose on the endpoints.
The diabetic group had a lower rate of live births (IRR 0.67 [95% CI 0.62-0.73]) than the non-diabetic group, and it was even lower when combined with hyperthyroidism (IRR 0.54 [0.39-0.74]). There were also fewer live births before a diagnosis of diabetes than after a diagnosis of diabetes (IRR 0.58 [0.52-0.65] vs. 0.80 [0.71-0.90]). Diabetic ketoacidosis and a higher daily insulin dose were strongly associated with abortion. Diabetic complications significantly reduced the number of live births.
Type 1 diabetes compromises female fertility, even before it is diagnosed. Associated hyperthyroidism further reduces fertility. Blood glucose and thyroid function surveillance in infertile females may allow for an early diagnosis of type 1 diabetes and associated thyroid disease.
本研究旨在评估台湾女性在诊断为 1 型糖尿病前后的生育率。还调查了可能影响生育的潜在风险因素。
我们使用来自台湾全民健康保险研究数据库的数据进行了这项回顾性、全国性、基于人群的匹配队列研究。糖尿病组（n=1191）包括 2000 年年龄在 16 至 30 岁之间的 1 型糖尿病女性。非糖尿病组（n=4764）按性别、性别、收入和城市化程度匹配。终点包括活产、流产和生育率，一直追踪到 2013 年底。使用泊松回归评估发病率比（IRR）。我们还分析了自身免疫性甲状腺疾病、糖尿病酮症酸中毒、糖尿病并发症和每日胰岛素剂量对终点的影响。
与非糖尿病组相比，糖尿病组的活产率较低（IRR 0.67 [95%CI 0.62-0.73]），与甲状腺功能亢进症合并时更低（IRR 0.54 [0.39-0.74]）。在诊断糖尿病之前，活产率也低于诊断糖尿病之后（IRR 0.58 [0.52-0.65] 与 0.80 [0.71-0.90]）。糖尿病酮症酸中毒和更高的每日胰岛素剂量与流产密切相关。糖尿病并发症显著降低了活产率。
1 型糖尿病会损害女性的生育能力，甚至在诊断之前就会损害。相关的甲状腺功能亢进症进一步降低了生育能力。对不孕女性进行血糖和甲状腺功能监测可能有助于早期诊断 1 型糖尿病和相关的甲状腺疾病。
