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Cited by 81Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Fluctuations of Hyperglycemia and Insulin Sensitivity Are Linked to Menstrual Cycle Phases in Women With T1D

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Brown, Sue A., Jiang, Boyi, McElwee-Malloy, Molly, Wakeman, Christian, Breton, Marc D.·2015·Journal of Diabetes Science and Technology
DOI 10.1177/1932296815608400PMC PMC4667305
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Abstract

Background: Factors influencing glycemic variability in type 1 diabetes (T1D) may play a significant role in the refinement of closed loop insulin administration. Phase of menstrual cycle is one such factor that has been inadequately investigated. We propose that unique individual patterns can be constructed and used as parameters of closed loop systems. Method: Women with T1D on continuous subcutaneous insulin infusion and continuous glucose monitoring were studied for 3 consecutive menstrual cycles. Ovulation prediction kits and labs were used to confirm phase of menstrual cycle. Glycemic risks were assessed using the low- and high blood glucose indices (LBGI and HBGI). Insulin sensitivity (SI) was estimated using a Kalman filtering method from meal and insulin data. Overall change significance for glycemic risks was assessed by repeated measures ANOVA, with specific phases emphasized using contrasts. Results: Ovulation was confirmed in 33/36 cycles studied in 12 subjects (age = 33.1 ± 7.0 years, BMI = 25.7 ± 2.9 kg/m 2 , A1c = 6.8 ± 0.7%). Risk for hyperglycemia changed significantly during the cycle ( P = .023), with HBGI increasing until early luteal phase and returning to initial levels thereafter. LBGI was steady in the follicular phase, decreasing thereafter but not significantly. SI was depressed during the luteal phase when compared to the early follicular phase ( P ≤ .05). Total daily insulin, carbohydrates, or calories did not show any significant fluctuations. Conclusions: Women with T1D have glycemic variability changes that are specific to the individual and are linked to phase of cycle. An increased risk of hyperglycemia was observed during periovulation and early luteal phases compared to the early follicular phase; these changes appear to be associated with decreased insulin sensitivity during the luteal phase.

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  • Previous studies have reported increased insulin requirements and deterioration of glycemic control from the mid- to late-luteal phases in women with type 1 diabetes.

    “Several previous studies have reported increased insulin requirements and deterioration of glycemic control from the mid‐ to late‐luteal phases in women with type 1 diabetes (T1D) 3 , 4 , 5 , 6 , 7 .”

    From A study of changes in insulin requirements related to the menstrual cycle in Japanese women with type 1 diabetes using the advanced hybrid closed‐loop system (2026) · cites this paper as [4]

    The paper’s background passage reports that earlier small studies found more frequent hyperglycemia during the luteal phase in women with T1D, and says insulin requirements can change across the cycle. It does not establish increased insulin requirements specifically from mid- to late-luteal phases. Its own Results report no significant fluctuation in total daily insulin and a hyperglycemia risk that rose until early luteal phase, then returned to initial levels (Abstract; Glycemic Risks, page unavailable). (LLM, conf=0.87)

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  • Our findings are consistent with previous studies on women with T1D treated with MDI or CSII, which consistently reported reduced insulin sensitivity and deterioration of glycemic control during the luteal phase.

    “Our findings are consistent with those of previous studies on women with T1D treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII), which consistently reported reduced insulin sensitivity and deterioration of glycemic control during the luteal phase 4 , 5 , 16 .”

    From A study of changes in insulin requirements related to the menstrual cycle in Japanese women with type 1 diabetes using the advanced hybrid closed‐loop system (2026) · cites this paper as [4]

    The Discussion reports increased hyperglycemia risk and lower insulin sensitivity in the luteal phase among women with T1D. But this study enrolled women using CSII, not MDI, and the Discussion reports that insulin sensitivity decreased in only 42% of individual cycles; the source therefore does not support the claim that studies consistently found both effects across women treated with MDI or CSII. (LLM, conf=0.88)

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  • The literature on the relationship between the menstrual cycle and insulin sensitivity/glycaemic control in type 1 diabetes is discordant.

    “However, the literature in this field is discordant, and the pathophysiological mechanism underlying IS changes observed during different phases of the MC remains still unclear [12,13,14].”

    From Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review (2023) · cites this paper as [12]

  • The pathophysiological mechanism underlying insulin sensitivity changes observed during different phases of the menstrual cycle remains unclear.

    “However, the literature in this field is discordant, and the pathophysiological mechanism underlying IS changes observed during different phases of the MC remains still unclear [12,13,14].”

    From Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review (2023) · cites this paper as [12]

  • Fourteen studies were included in the systematic review.

    “We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients.”

    From Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review (2023) · cites this paper as [12]

    The Study Design and Subjects section describes a prospective trial that recruited 15 women, and the Results report that 12 completed it. The cited paper does not report a systematic review or its number of included studies (searched for 14 studies and systematic-review inclusion). The citing sentence’s “we included” appears to describe the citing authors’ own review, which this source cannot verify. (LLM, conf=0.77)

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Authors
Brown, S. A., Jiang, B., McElwee-Malloy, M., Wakeman, C., & Breton, M. D.
Affiliations
University of Virginia (US)
Corresponding author
Brown, Sue A.
ORCID
Venue
Journal of Diabetes Science and Technology
Publisher
SAGE Publications
Published
2015-10-14
Volume
9
Issue
6
Pages
1192-1199
ISSN
1932-2968 (ISSN-L)
DOI
10.1177/1932296815608400
PMC
PMC4667305
OpenAlex
W2410556865
Cited by
81
References
16
Citations by year
2026: 13 · 2025: 15 · 2024: 7 · 2023: 8 · 2022: 10 · 2021: 7 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 3
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Diabetes Science and Technology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Virginia
  • Johnson and Johnson
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, menstrual cycle phases, glycemic variability, hyperglycemia, insulin sensitivity, luteal phase, follicular phase, ovulation, artificial pancreas, continuous glucose monitoring, insulin pump therapy, Kalman filter, women
MeSH terms
Adult, Blood Glucose, Diabetes Mellitus, Type 1, Equipment Design, Female, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Insulin Resistance, Menstrual Cycle, Models, Biological, Pilot Projects, Prospective Studies, Risk Factors, Time Factors, Blood Glucose Self-Monitoring, Biomarkers, Treatment Outcome, Pancreas, Artificial, Infusions, Subcutaneous

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