Type 2 Diabetes and Puberty in Young Women

Dr. Fran Cogen Health Pro
  • A great deal of research revolves around trying to prevent the development of diabetes by ameliorating risk factors such as obesity and decreased exercise. But what about the risk factors that cannot be changed such as genetics, familial disposition, ethnic background, and age at first menstruation (menarche)?


    According to the paper, Age at Menarche and Type 2 Diabetes Risk- the Epic- InterAct Study authored by Elks, Ong, Scott et al in the October issue of Diabetes Care (Diabetes Care 36:3526-3534, 2013), a statistically significant relationship exists such that women with an history of earlier menarche are at greater risk of developing type 2 diabetes when they become adults. According to the authors, less than 50 percent of the association is related to elevated adult BMI, "suggesting that early pubertal development also may directly increase type 2 diabetes risk.”

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    What was the study's method and who were the participants?


    The participants were selected from The European Prospective Investigation into Cancer and Nutrition (EPIC) InterAct case cohort study which included a subcohort of 16,154 individuals from 26 research centers across eight European countries. The authors tested the association between age at menarche and incidence of type 2 diabetes employing regression analysis in 15,168 women (total 5995 cases of type 2 DM). Of major important, models of the regression analysis were adjusted for potential confounding variables including adult BMI.


    What were the results?


    The average age of first menstrual period ranged from 12.6 to 13.6 in the participating European countries. "Each year later menarche was associated with a 0.32 kg/m2 lower adult BMI." Women with menarche starting between age 8 and 11 years (2148 participants) had a 70 percent higher incidence of type 2 diabetes as compared to those who began their menses at age 13 years (3634 participants) (P<0.001). However, later menarche beyond the median age (age at which 50 percent are above and 50 percent are below) was not protective of type 2 diabetes.


    What may we conclude from this study?


    According to the authors, these findings suggest that "early puberty has an effect on metabolic disease risk, which is partly mediated by increased BMI, but also has some direct effect through other biological pathways that act independently of obesity. Overall early menarche conferred a 42 percent increase in the risk of development of diabetes independently of adult BMI."  The authors were unable to provide the reason for this association, but speculated that the relationship may exist because early menarche may be a "marker" for a higher BMI before puberty. Thus, the longer one has an elevated BMI, the greater the risk for the development of diabetes.


    What were the limitations of the study?

    1. The age of menarche was recalled in adulthood and was only recorded to the nearest year.

    2.  It is also possible that BMI may account for both obesity and fat free mass.

    3.  It is possible that imprecise measurements could lead to inaccuracies.


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    In conclusion, it appears that there are many co-variables that contribute to the development of type 2 diabetes. The findings, based on this study, suggest that by attempting to prevent becoming overweight or obese, one may reduce the risk of type 2 diabetes in women with early menarche, but the authors suggest that one might consider strategies to prevent early menarche - which may lead to controversy in the pediatric endocrinology field.

Published On: November 05, 2013