Menopause increases the risk of diabetes, and this association might be due to iron metabolism

Introduction Type 2 diabetes mellitus (T2DM) is a serious public health concern with a considerable impact on human life and health expenditures. Interestingly, Emerging evidence indicates that the risk and clinical features of cardiometabolic diseases, like T2DM, may vary among women based on their menopausal status (Figure1). In addition to hormonal changes, iron and its markers have been closely related to glucose metabolism and T2DM. Increased serum ferritin, reflecting body iron overload, is often associated with elevated blood glucose and insulin levels, as well as with increased risk of insulin resistance. One the other hand, iron biomarker levels differ in females in different reproductive stages. Goals In this study, we aimed to investigate: 1) the association of menopausal status with T2DM risk, and 2) the association of menopause with iron biomarkers and of iron biomarkers with T2DM risk. Method Data from the prospective CoLaus|PsyCoLaus study, conducted in our city. Of the initial 3544 women aged 35-75, 2002 (55.8% of the initial sample) were eligible for analysis after applying exclusion criteria. The associations between menopause and incidence of T2DM were assessed using time-varying Cox models, and linear mixed models assessed how changes in menopause status influenced iron biomarkers during this period. Subsequently, a time-varying Cox model investigated the association between iron biomarkers and incident T2DM. Result After adjustment for potential confounders (age , BMI , smoking status , hormone replacement therapy use, C-Reactive Protein), menopause status was associated with an increased risk of T2DM: multivariable-adjusted hazard ratio (HR) 2.88 (95% CI: 1.91-3.81). Non-significant associations with risk of T2DM were observed for iron (HR: 1.06, 95% CI: 0.59-2.98), ferritin (HR: 1.09, 95% CI: 0.85-1.38), or TSAT (HR: 0.98, 95% CI: 0.88-1.05), while transferrin demonstrated a significant positive association (HR: 1.33, 95% CI: 1.11-1.58). In a multivariable-adjusted linear mixed model investigating the longitudinal relationship between menopause status and iron biomarkers, a statistically significant association was found for all evaluated iron biomarkers (Table1). Conclusion We found a significant association between menopause status and risk of T2DM, and between transferrin and risk of T2DM. Changes in transferrin levels could partly explain the increased risk of T2DM observed after menopause.