Women who worked a rotating night shift had an increased risk of type 2 diabetes that was not completely explained by an increase in body mass index (BMI), according to results of a prospective study of women who were enrolled in the Nurses' Health Studies.  Nurses who had 1 to 10 years of night shift work  saw a 5% excess risk for type 2 diabetes compared to women who did minimal to no night shift work. That risk climbed to 40% after a decade of shift work, according to Frank Hu, MD, PhD, from Brigham and Women's Hospital/Harvard School of Medicine in Boston, and colleagues.

Excess risk rocketed to almost 60% for those who had put in 20 years or more, the group reported. Other studies have suggested that rotating night shift work is associated with an increased risk for obesity and metabolic syndrome, both of which are conditions related to type 2 diabetes, they wrote.

Hu's group examined the relationship between the duration of rotating night shift work and the risk of type 2 diabetes in U.S. women who participated in Nurses' Health Studies (NHS) I and II. They also looked at whether greater weight gain was linked to duration of shift work.

Collectively, NHS I and II enrolled nearly 240,000 women. For this study, the women who completed the NHS questionnaire in 1988 or 1989 served as the baseline for this particular study. Participants were excluded if they had diabetes, heart disease, stroke, or cancer at baseline. Follow-up took place at 18 to 20 years.

Rotating night shifts were defined as working at least three nights a month in addition to days and evenings in that same month. The control group consisted of women who did not report a history of rotating night shift work.  In both cohorts, women who spent more years in night shift work were older, more likely to have a higher BMI, and be smokers.

In a secondary analysis, they found that night shift work was also associated with an elevated risk for obesity and excessive weight gain during the follow-up period.   They suggested that, beyond BMI, a reason for the link between shift work and type 2 diabetes may be "chronic misalignment between the endogenous circadian timing system and the behavior cycles." This misalignment has been pegged as a reason for metabolic and cardiovascular disorders, including increases in glucose and insulin, they wrote.

In an accompanying commentary, Mika Kivimäki, PhD, from University College London, and colleagues said the study "probably represents the most accurate estimate of shift work-type 2 diabetes association available to date, suggesting this effect is comparable in size to that of work stress in coronary heart disease and larger than the effect of work stress on type 2 diabetes."

They suggested that in an increasingly "24/7" society, efforts need to be made to prevent type 2 diabetes among shift workers by promoting healthy lifestyle and weight control. Also, prediabetic and diabetic employees need to be identified early and treated accordingly.
Source reference:
Hu FB, et al  PLoS Medicine 2011; 8(12).

This sounds like a headline that  Jay Leno would satirize on his late night show!   Low-income women with children who move from high-poverty to lower-poverty neighborhoods experience notable long-term improvements in diabetes and extreme obesity, according to a new study.     While I appreciate that this study was the first to employ a important randomized experimental design to learn and document the connections between neighborhood poverty and health,  I can't help but be struck by the obvious:  Nice neighborhoods have good schools, parks, low crime, and  grocery stores---something the women in the study did not have before moving.

To be fair, this is well designed study that provides sound evidence that "environments in low-income neighborhoods can contribute to poor health".   Good evidence is important to make a case for change.   Now that we have proof,  what are we, as a nation, going to do about it?   Our economic situation locally and nationally is pretty grim right now and we can't afford to give out housing vouchers to everyone who wants to move. Hopefully, the results of this study, will be used appropriately by our legislators in creating real policy for change and not political platitudes!

To read more about the study click HERE.

Menopause has little to no impact on whether women become more susceptible to diabetes, according to a one-of-a-kind study.

Postmenopausal women had no higher risk for diabetes whether they experienced natural menopause or had their ovaries removed, according to the national clinical trial of 1,237 women at high risk for diabetes, ages 40 to 65.“In our study, menopause had no additional effect on risk for diabetes,” says study lead author Catherine Kim, M.D., M.P.H., an associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System. “Menopause is one of many small steps in aging and it doesn’t mean women’s health will be worse after going through this transition.”

Kim and colleagues in the Diabetes Prevention Program Research Group will publish their results in the August issue of Menopause.  The findings also shed light on the impact of diet and exercise and hormone replacement therapy on the health of postmenopausal women.

Previous evidence has suggested that menopause would speed the progression to diabetes because postmenopausal women have relatively higher levels of the hormone testosterone, which is considered a risk factor for diabetes. But the recent study shows healthy outcomes for postmenopausal women.

The women in the study were enrolled in the Diabetes Prevention Program, a clinical trial of adults with glucose intolerance, meaning tests show their body’s struggle to process glucose, or blood sugar, into energy.

Glucose intolerance is often a pre-stage to diabetes, a condition common later in life and is diagnosed when the body has abnormally high levels of blood sugar. Age, weight, physical activity and family history can contribute to type 2 diabetes.

But Diabetes Prevention Program researchers have shown lifestyle intervention and the blood sugar-lowering drug metformin can prevent diabetes in those with glucose intolerance. The interventions work well in women who have gone through menopause.

Menopause is the end of monthly periods and chance for pregnancy and estrogen production by the ovaries stops. In the United States, menopause happens around age 51 or 52.

The research is considered the only menopause study that specifically analyzed the impact of diabetes on women who had natural menopause and those who had their ovaries removed. Most other studies mixed them together or excluded one group.

According to the new study, for every year 100 women were observed, 11.8 premenopausal women developed diabetes, compared to 10.5 among women in natural menopause and 12.9 cases among women who had their ovaries removed.

However for women whose estrogen production ended as a result of having their ovaries removed, and engaged in lifestyle changes, cases of diabetes were extremely low. For every year 100 of these women were observed, only 1.1 women developed diabetes.Lifestyle changes included losing 7 percent of their body weight and exercising for at least 150 minutes a week. For instance, a 180-pound postmenopausal woman would see benefits from losing 12.6 pounds.

The results among this group were surprising considering almost all of the women who had their ovaries removed were on hormone replacement therapy, a regime that women and doctors fear puts them at risk for a host of health issues. Study authors say more research is needed on the role of hormone therapy and diabetes risk.

“Physicians can be empowered to tell women that lifestyle changes can be very effective, and that menopause does not mean that they have a higher risk of diabetes,” Kim says.

Source: University of Michigan Health System

A new report Women at High Risk for Diabetes: Access and Quality of Health Care, 2003–2006 was released on February 14, 2011 by the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) . The full report can be downloaded or free print copies ordered HERE .

Using the most scientifically based measures and national data sources available, this collaborative effort compared the quality of preventive health care received by U.S. women at high risk for diabetes with that for U.S. women not at high risk for diabetes. The report presents quality measures across several crucial elements of health care: access to care, general health and wellbeing, and use of preventive care and behaviors.
Among the report’s major findings:
·         Regardless of diabetes risk status, minority women, women with low levels of education, or women who lived in low income families more often reported having fair-to-poor health.
·         Regardless of diabetes risk status, women with a high school education or less were significantly more likely than women with more than a high school education to have been uninsured all year.
·         Women at high risk for diabetes who had a high school education or less were significantly less likely than women at high risk for diabetes who had more than a high school education to have tried to lose weight in the past year.
·         Women at high risk for diabetes were significantly less likely than women not at high risk for diabetes to report that they were physically active 150 minutes per week, the level of moderate physical activity per week recommended as part of a strategy to prevent or delay onset of type 2 diabetes.

Additional resources on diabetes and women can be found HERE.