Type 2 diabetes: Why diagnosis should be changed for women under 50

Evan Walker
Evan Walker TheMediTary.Com |
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Experts say blood sugar levels can be affected by menstruation in women under 50. Maskot/Getty Images
  • Researchers suggest lowering the threshold for a type 2 diabetes diagnosis in women under 50 might be more accurate.
  • They say that women are less likely to receive treatment, risk-reduction interventions, and medication such as statins, aspirin, and beta blockers than men.
  • Diabetes affects more than 37 million people in the United States.

It may be prudent to lower the threshold for diagnosing type 2 diabetes for women under 50, according to a study presented at the annual meeting of the European Association for the Study of Diabetes.

Dr. Adrian Heald, a study author and a consulting physician at East Cheshire NHS Trust in the United Kingdom, explains that natural blood loss through menstruation can affect blood sugar levels in women.

In this study, the researchers looked at whether a diagnosis of type 2 diabetes in women could be attributed to glycated hemoglobin, HbA1c, levels due to hemoglobin replacement linked to menstrual blood loss.

The scientists theorize that red blood cell survival is shorter for menstruating women. However, a diagnosis of type 2 diabetes is currently based on HbA1c, regardless of age or sex.

The researchers suggest that a slightly lower point for type 2 diabetes for premenopausal women may be appropriate.

They said blood replacement during menstruation could result in missed diagnoses and opportunities for interventions.

The researchers examined HbA1c testing across seven United KIngdom laboratory sites.

They assessed the sex and age differences of those who underwent a single test, had not been diagnosed with diabetes and had an HbA1c of equal to or less than 50 mmol/mol. An HbA1c of 48 mmol/mol is recommended as the cutoff point for diagnosing diabetes.

“This is equal to 6.5 A1C, which is consistent with a diagnosis of diabetes. The authors are suggesting that we reduce this to 6.4 A1C for premenopausal women,” Dr. Caroline Messer, an endocrinologist at Northwell Lenox Hill Hospital in New York who was not involved in the study, told Medical News Today.

The analysis showed that almost 35,000 more women in England would be diagnosed with type 2 diabetes if the classification changed. Lifestyle changes and diabetes treatment could then be initiated for these women, improving their health outcomes in both the short and long term, the researchers said.

They added that Health professionals could also be on the lookout for cardiovascular risk factors in these women. The authors note that diabetes is a more substantial risk factor for cardiovascular disease in women than men.

The researchers said that women are less likely to receive treatment, risk-reduction interventions, and medication such as statins, aspirin, and beta blockers than men.

Timely identification and treatment can reduce the risk and potentially improve women’s quality of life and life expectancy. Based on this, the scientists suggest that medical professionals reevaluate HbA1c thresholds for this group.

“In the era of personalized medicine, it is sobering to realize that we are under-diagnosing diabetes due to flawed methodology,” Messer said. “I am quite convinced that this is logically and scientifically sound given the nearly identical expected and actual impact on A1C from the amount of blood loss in the average menstruating female over a four-month period. Endocrinologists are generally well aware that various types of anemia can affect the accuracy of hemoglobin A1C readings. I am actually just surprised that this study was not done earlier.”

“This could clearly improve the ability of premenopausal women to obtain coverage for prohibitively expensive medications like Ozempic and Mounjaro,” she added. “The major drawback to the study is there are already many instances of false positive hemoglobin A1Cs and lowering the threshold could lead to widespread panic.”

Experts say flawed or inaccurate test results could be devastating for women. For example, a false negative could delay treatment. There are, however, different ways of detecting diabetes if the medical professional doctor feels a result may not be accurate.

“Hemoglobin a1c is one the of tests that can be used,” said Dr. Priya Jaisinghani, an endocrinologist at NYU Langone Health in New York. “We know that hemoglobin a1c can be affected by many factors that alter red blood cell life span, production of red blood cells, glycation, or assay interference.”

“There are other tests the [American Diabetes Association] uses to diagnose diabetes, such as fasting blood glucose and oral glucose tolerance test,” Jaisinghani told Medical News Today. “It’s also important to look at blood glucose readings, especially when results or values are unexpected or discordant. In special cases, we also look at other measures such as fructosamine to approximate blood glucose levels.”

“More studies may be needed to look into gender differences, diagnostic tests such as hemoglobin a1c, and outcomes in order to make sure women are being diagnosed and treated for diabetes in a timely manner” she added.

Diabetes affects more than 37 million Americans, according to the Centers for Disease Control and Prevention (CDC).

Approximately 90% to 95% of these cases are type 2 diabetes. Typically, the disease occurs in people over 45, but children, teens, and young adults can also develop it.

The pancreas produces insulin to let sugar into your cells where it can be used as energy. If your body does not respond typically to insulin, a condition known as insulin resistance, the pancreas makes more to try to get the cells to respond.

Eventually, your pancreas can’t keep up and sugar builds up in your bloodstream. High blood sugar puts you at risk for Health problems such as heart disease, vision loss, and kidney disease.

Some common symptoms of type 2 diabetes
Frequent urination
Excessive thirst
Frequent hunger
Blurry vision
Numbness in hands or feet

Lifestyle choices, such as a healthy diet and regular exercise, are important when you have type 2 diabetes.

Some people require medications to help control their blood sugar. According to the American Diabetes Association, these include:

  • metformin
  • DPP-4 inhibitors, such as Tradjenta, Onglyza, Januvia
  • GLP-1 and dual GLP-1/GIP receptor agonists, such as Ozempic
  • SGLT2 Inhibitors, such as Jardiance, Farxiga
  • sulfonylureas, such as glimepiride
  • thiazolidinediones (TZDs)

Long-term weight loss requires a combination of diet, exercise, and behavioral changes, according to Anne Danahy, MS, RDN, a Arizona-based registered dietician and integrative nutritionist.

Danahy offers the following tips:

  • Plan meals ahead of time to avoid getting off track.
  • Limit highly processed food such as fast food as well as packaged, ready-to-eat, and snack foods.
  • Include lots of high fiber plant foods. These include fruits, vegetables, beans, legumes, whole grains, and nuts. These are relatively low in calories and their fiber fills you up.
  • Increase daily activity and try to do strength training at least three times a week.

If you find yourself falling back into old habits or struggling to create a healthy meal, you might benefit from working with a nutritionist, Danahy told Medical News Today.

She said health and wellness professionals can work with you to create dietary programs and nutrition plans that are sustainable for your lifestyle.

Some other ways that these professionals can help include:

  • Educating you on food and nutrition in general as well as giving you a better understanding on your dietary requirements.
  • Providing a shopping list that includes foods that will meet your nutritional needs.
  • Addressing any gastrointestinal issues.

Danahy noted that a health professional can typically meet with a person with type 2 diabetes on a weekly, biweekly, or monthly basis.

These regular meetings provide accountability and motivation to continue nutrition programs.

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