A Pilot on the Endocrine Effects of Hormonal Replacement Therapy on Menopausal T1 Diabetics Using Wearable Sensors

Menopause is an under-reported and under-researched life stage for women living with Type One Diabetes (T1D) despite it lasting approximately 20 years. Menopause is associated with metabolic dysfunction leading to weight gain, impaired insulin sensitivity, hypertension and hypercholesterolaemia, each of which diminishes longevity for women living with diabetes. Its symptoms, affecting cognition, sleep patterns, mood, cardiac and vascular health, and physical health, are known to impact glucose variability dynamics. Associated vasomotor symptoms of hot-flushes/night-sweats, mood swings, anxiety, depression, and sexual dysfunction make it difficult to differentiate between symptoms of menopause and hypoglycaemia. While it is recognised that transitioning through menopause increases the potential for developing diabetes, there are no recommendations on managing glucose variability or insulin resistance for women with pre-existing diabetes.

Increasingly, women using wearable glucose sensor technologies, insulin pumps and artificial pancreas systems, have self-identified increased glucose variability in the data sets provided by wearable digital health technologies. This data, collected in real-time from women outside of traditional research settings, would have been unimaginable 20 years ago. Women highlighting the knowledge deficit are driven to learn and share more about menopause. Their quest for clinician support about the impact of hormone replacement therapies (HRT) on glycaemic variability, the associated risk of developing additional comorbidities further illustrates the importance of this subject.

This work uses datasets from wearable sensors, contributed by women with T1D to inform an understanding of their collective perimenopause and menopause journeys. Glucose readings across a number of weeks, leading up to and immediately following the initiation of prescribed medications, have been analysed to investigate the physiological effects of HRT on the endocrine system of this sample of menopausal T1D women. Self-management and peer support is bridging the research void, which is why there should be more research into this topic.