(05-10-09) The Association of Endogenous Sex Hormones, Adiposity, and Insulin Resistance

with Incident Diabetes in Postmenopausal Women.



Rastogi Kalyani R, Franco M,
Dobs AS, Ouyang P, Vaidya D, Bertoni A, Gapstur SM, Hill Golden S.
Departments of Medicine (R.R.K., A.S.D., P.O., D.V., S.H.G.) and Epidemiology

(S.H.G.), Johns Hopkins University, Baltimore, Maryland 21287; Department of Epidemiology and Population Genetics (M.F.), Centro Nacional Investigaci?n Cardiovascular, 28029 Madrid, Spain; Department of Epidemiology and Prevention (A.B.), Wake Forest University, Winston-Salem, North Carolina 27157; and
Department of Epidemiology (S.M.G.), American Cancer Society, Atlanta, Georgia 30303.

Context: In postmenopausal women, endogenous bioavailable testosterone (T) and estradiol (E2) have been positively associated, and SHBG has been negatively associated, with incident type 2 diabetes (T2DM). Previous studies have not explored possible factors explaining these relationships.
Objective:
Our objective was to examine the association of endogenous sex hormones with incident T2DM in postmenopausal women and possible explanatory factors. Design, Setting, and Participants: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective study that included 1612 postmenopausal women aged 45-84 yr, followed between the years 2000-2006, who were not taking hormone replacement
therapy, had no prevalent cardiovascular disease or diabetes, and had complete ascertainment of sex hormones. Main Outcome Measures: T2DM was defined based on fasting glucose and/or treatment for diabetes. Results: There were 116 incident cases of diabetes during follow-up. Across higher quartiles of bioavailable T and E2 and lower quartiles of SHBG, we found significantly greater hazards of
developing incident T2DM (all P for trend The associations of E2 and SHBG with incident T2DM were partially explained by body mass index and insulin resistance but persisted in fully adjusted models (both P for trend <0.02). Dehydroepiandrosterone had no relationship with incident T2DM. Conclusions: Adiposity and insulin resistance explained most of the association of bioavailable T but only partially explained the associations of E2 and SHBG with incident T2DM among postmenopausal women.


Source: J Clin Endocrinol Metab. 2009 Sep 29.

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