Ovarian reserve, oxidative stress and glycemic profile parameters in women with type 1 diabetes mellitus using different insulin therapy regimens

BACKGROUND : Women with type 1 diabetes mellitus (DM) have a high frequency of menstrual irregularities and perinatal complications. New methods for monitoring the glycemic profile provide opportunities to analyze the effectiveness of insulin therapy regimens in maintaining the reproductive health of these patients. AIM: The aim of the study was to assess the relationship between glycemic profile patterns, pro- and antioxidant statuses, and ovarian reserve parameters in type 1 DM patients. MATERIALS AND METHODS : This study included 60 type 1 DM women, of whom 30 patients aged 33.0 [30.0; 35.0] years used the multiple insulin injections (MII) regimen (Group 1). In this group, patients were divided into two subgroups: not exceeding the percentage of hyperglycemia above the target range for more than 35% of the day (Group 1A) and exceeding this range (Group 1B). The continuous subcutaneous insulin infusion (CSII) regimen was administered to other 30 patients (Group 2). They were subdivided identically into Groups 2A and 2B. We analyzed continuous glucose monitoring data using the FreeStyle Libre Flash Glucose Monitoring System and evaluated blood malonic dialdehyde level, catalase activity and 3-nitrotyrosine level, as well as ovarian volume, antral follicle count, anti-Müllerian hormone and follicle-stimulating hormone levels. RESULTS : We found no differences in the time in range in Groups 1A and 2A. The HbA1c level was higher in the time above range group of women using MII. Blood 3-nitrotyrosine level in Group 1B was 161.4 [110.6; 232.1] nmol/l and differed from that in Group 2B (42.4 [19.1; 64.9] nmol/l; p<0.01). A relationship was found between catalase activity and soluble receptor for advanced glycation end-products (sRAGE) levels in Group 2A (rs=0.857; p<0.05). The antral follicle count tended to increase when the target range of glucose levels was exceeded above 7.8 mmol/l for more than 35% of the day. CONCLUSION : Preliminary data were obtained on the relationship between hyperglycemia exceeding 7.8 mmol/l for more than 35% of the day with oxidative stress parameters, sRAGE levels, and a tendency towards an increase in the antral follicle count in women with type 1 DM.