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The Association of Increased Total Glycosylated Hemoglobin Levels with Delayed Age at Menarche in Young Women with Type 1 Diabetes

Department of Population Health Sciences (K.K.D., M.P., C.A., D.J.D.), Biostatistics and Medical Informatics (M.P.), and Medicine (D.J.D.), University of Wisconsin, Madison, Wisconsin 53726-2397

Address all correspondence and requests for reprints to: Dr. Kirstie K. Danielson, WARF Building, 610 Walnut Street, Madison, Wisconsin 53726-2397. E-mail: kdaniel2{at}wisc.edu.

Context: Delayed menarche is associated with subsequent reproductive and skeletal complications. Previous research has found delayed growth and pubertal maturation with type 1 diabetes and poor glycemic control. The effect of diabetes management on menarche is important to clarify, because tighter control might prevent these complications.

Objective: The objective of this study was to investigate age at menarche in young women with type 1 diabetes and examine the effect of diabetes management [e.g. total glycosylated hemoglobin (GHb) level, number of blood glucose checks, insulin therapy intensity, and insulin dose] on age at menarche in those diagnosed before menarche.

Design: The Wisconsin Diabetes Registry Project is a follow-up study of a type 1 diabetes population-based incident cohort initially enrolled between 1987 and 1992.

Setting: This study was performed in 28 counties in south-central Wisconsin.

Patients or Other Participants: The study participants were recruited through referrals, self-report, and hospital/clinic ascertainment. Individuals with newly diagnosed type 1 diabetes, less than 30 yr old, were invited to participate. Of 288 young women enrolled, 188 reported menarche by 2002; 105 were diagnosed before menarche.

Interventions: There were no interventions.

Main Outcome Measure: The main outcome measure was age at menarche.

Results: Mean age at menarche was 12.78 yr, compared with 12.54 yr in the United States (P = 0.01). Ages at menarche and diagnosis were not associated. For those diagnosed before menarche, age at menarche was delayed 1.3 months with each 1% increase in mean total GHb level in the 3 yr before menarche.

Conclusions: Age at menarche was moderately delayed in young women with type 1 diabetes. Delayed menarche could potentially be minimized with improved GHb levels.

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