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      Menarchal Timing in Type 1 Diabetes Through the Last 4 Decades

      research-article
      , DO, , MD, , PHD
      Diabetes Care
      American Diabetes Association

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          Abstract

          OBJECTIVE

          We sought to examine whether age at menarche has changed over the past 4 decades by comparing age at menarche by year of diagnosis with type 1 diabetes.

          RESEARCH DESIGN AND METHODS

          This work consisted of a cross-sectional study of age at menarche in two cohorts: adolescents (ages 11–24 years, n = 228) and adults (ages 19–55 years, n = 290, enrolled in the Coronary Artery Calcification in Type 1 Diabetes study).

          RESULTS

          The adolescent cohort reported a younger age of menarche than the adult women with type 1 diabetes (12.69 ± 0.08 vs. 13.22 ± 0.12 years, mean ± SE, P < 0.001). Age at menarche was later in both adolescent girls and adult women with type 1 diabetes diagnosed before menarche (12.82 ± 1.16 and 13.7 ± 2.23 years) than for individuals diagnosed after menarche (12.12 ± 1.25 and 12.65 ± 1.38 years, P < 0.001 for both). Age at menarche was then examined by decade of type 1 diabetes diagnosis (1970–1979, 1980–1989, 1990–1999, and 2000–2009). Age at menarche significantly declined over the 4 decades ( P = 0.0002). However, the delay in menarche among girls diagnosed with type 1 diabetes before menarche compared with those diagnosed after menarche was also significant across all decades ( P < 0.0001) and did not change significantly over time ( P = 0.41 for interaction of cohort and diagnosis premenarche).

          CONCLUSIONS

          Age at menarche has declined over the past 4 decades among girls with type 1 diabetes, but a delay in age at menarche remains among individuals diagnosed before menarche compared with individuals diagnosed after menarche.

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          Most cited references11

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          Diagnosis and classification of diabetes mellitus.

          (2004)
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            Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005).

            Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the current-day clinical course of T1DM. An analysis of the cumulative incidence of long-term complications was performed. The DCCT (1983-1993) assigned patients to conventional or intensive therapy. Since 1993, the DCCT has been observational, and intensive therapy was recommended for all patients. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study is an observational study of patients with T1DM from Allegheny County, Pennsylvania. The study population comprised the DCCT T1DM cohort (N = 1441) and a subset of the EDC cohort (n = 161) selected to match DCCT entry criteria. In the DCCT, intensive therapy aimed for a near-normal glycemic level with 3 or more daily insulin injections or an insulin pump. Conventional therapy, with 1 to 2 daily insulin injections, was not designed to achieve specific glycemic targets. Main outcome measures included the incidences of proliferative retinopathy, nephropathy (albumin excretion rate >300 mg/24 h, creatinine level >or=2 mg/dL [to convert to micromoles per liter, multiply by 88.4], or renal replacement), and cardiovascular disease. After 30 years of diabetes, the cumulative incidences of proliferative retinopathy, nephropathy, and cardiovascular disease were 50%, 25%, and 14%, respectively, in the DCCT conventional treatment group, and 47%, 17%, and 14%, respectively, in the EDC cohort. The DCCT intensive therapy group had substantially lower cumulative incidences (21%, 9%, and 9%) and fewer than 1% became blind, required kidney replacement, or had an amputation because of diabetes during that time. The frequencies of serious complications in patients with T1DM, especially when treated intensively, are lower than that reported historically.
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              Age at menarche and racial comparisons in US girls.

              Concern regarding change in the onset of sexual maturation of US girls has increased the need for current information on age at menarche from a national sample. Previous reports have been sparse and interpretation has been limited because of the racial composition and ages of the samples. The objectives of this study were to estimate the distribution of age at menarche for all US girls and for non-Hispanic white, black, and Mexican American girls in the Third National Health and Nutrition Examination Survey and to test for racial differences. Menstrual status data were collected from 2510 girls aged 8.0 to 20.0 years. The Third National Health and Nutrition Examination Survey followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate proportions of girls reaching menarche at an age. Ages at menarche were estimated by probit analysis at the ages at which 10%, 25%, 50%, 75%, and 90% of the girls attained menarche. Less than 10% of US girls start to menstruate before 11 years, and 90% of all US girls are menstruating by 13.75 years of age, with a median age of 12.43 years. This age at menarche is not significantly different (0.34 years earlier) than that reported for US girls in 1973. Age at menarche for non-Hispanic black girls was significantly earlier than that of white girls at 10%, 25%, and 50% of those who had attained menarche, whereas Mexican American girls were only significantly earlier than the white girls at 25%. Overall, US girls are not gaining reproductive potential earlier than in the past. The age at menarche of non-Hispanic black girls is significantly earlier than that of non-Hispanic white and Mexican American girls.
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                Author and article information

                Journal
                Diabetes Care
                diacare
                dcare
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                0149-5992
                1935-5548
                December 2010
                15 September 2010
                : 33
                : 12
                : 2521-2523
                Affiliations
                [1]From the Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, and The Children's Hospital, Aurora, Colorado.
                Author notes
                Corresponding author: Janet K. Snell-Bergeon, janet.snell-bergeon@ 123456ucdenver.edu .
                Article
                0872
                10.2337/dc10-0872
                2992181
                20843975
                1949c112-3d7e-43d2-8403-285a7f40ced3
                © 2010 by the American Diabetes Association.

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                History
                : 9 May 2010
                : 6 September 2010
                Categories
                Original Research
                Clinical Care/Education/Nutrition/Psychosocial Research

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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