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Delayed menarche in young German women with type 1 diabetes mellitus: recent results from the DPV diabetes documentation and quality management system

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Abstract

Background

Findings have been inconsistent regarding the effect of T1DM (type 1 diabetes) on age at menarche.

Objective

The purpose was to investigate in young German women with T1DM menarcheal age and factors potentially affecting menarche, including glycemic control, BMI (body mass index), relative T1DM duration (proportion of life with diabetes), insulin dose, and insulin therapy intensity. Initiated in 1990, the DPV program is an ongoing, prospective long-term longitudinal follow-up study to benchmark the quality of care provided to pediatric and, more recently, adult diabetes patients. Two hundered two German diabetes centers participated in nationwide data collection. Based on ethnicity and the availability of menarche and T1DM onset data as the main inclusion criteria, 643 young German women were selected from 11,629 female T1DM patients aged <20 years, recruited by referral, clinic or hospital ascertainment, or self report. Mean age at menarche (±SD) was 13.22 ± 1.31 years, representing a delay of 0.52 years (p < 0.001) relative to the general population. Significant delay (p < 0.05) was also found for relative T1DM duration, BMI SD score, insulin dose, and HbA1c level, with a 1% increase in HbA1c resulting in a delay in menarche by 0.07 years.

Conclusions

Age at menarche is delayed in type 1 diabetes mellitus. The delay increases with relative T1DM duration and poor quality of glycemic control.

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Acknowledgements

The DPV program was supported by the German Federal Ministry of Health, the German Diabetes Society (DDG), the Dr. Bürger-Büsing Foundation, the German Research Foundation (DFG), the National Action Forum on Diabetes Mellitus (NAFDM), the German Medical Association (Bundesärztekammer), and Novo Nordisk Pharma GmbH, Germany.

The authors are grateful to Professors Ludwig Gortner and Norbert Graf for helpful discussions and wish to acknowledge all patients, investigators, and staff who participated in the DPV initiative. The following centers contributed data to the present study:

Aachen, Uni-Kinderklinik RWTH; Ahlen, St. Franziskus Kinderklinik; Altötting, Zentrum Inn-Salzach; Asbach, Kamillus-Klinik Innere; Aue, Helios Kinderklink; Augsburg, Innere; Augsburg, Kinderklinik Zentralklinikum; Aurich, Kinderklinik; Bad Aibling, Internist. Praxis; Bad Driburg/Bad Hermannsborn, Innere; Bad Hersfeld, Kinderklinik; Bad Kreuznach, St.Marienwörth-Innere; Bad Kösen, Kinder-Rehaklinik; Bad Lauterberg, Diabeteszentrum Innere; Bad Oeynhausen, Diabetesfachklinik; Bad Reichenhall, Innere; Bad Säckingen, Hochrheinklinik Innere; Berlin, Kinderklinik Lindenhof; Berlin Klinik St. Hedwig Innere; Berlin, Schlosspark-Klinik Innere; Berlin, St. Josephskrankenhaus Innere; Berlin, Virchow-Kinderklinik; Berlin-Hellersdorf, Innere; Bielefeld, Kinderklinik Gilead; Bocholt, Innere Medizin; Bonn, Uni-Kinderklinik; Bottrop, Kinderklinik; Bottrop, Knappschaftskrankenhaus Innere; Bremen, Kinderklinik Nord; Bremen, Kinderklinik St.Jürgenstrasse; Bremen, Epidemiologieprojekt; Bremerhaven, Kinderklinik; Celle, Kinderklinik; Chemnitz, Kinderklinik; Coesfeld, Kinderklinik; Darmstadt, Kinderklinik Prinz. Margareth; Datteln, Vestische Kinderklinik; Deggendorf, Kinderarztpraxis; Deggendorf, Kinderklinik; Deggendorf, Medizinische Klinik II; Delmenhorst, Kinderklinik; Detmold, Kinderklinik; Dortmund, Kinderklinik; Dortmund, St. Josefshospital Innere; Dresden, Uni-Kinderklinik; Düren, Birkesdorf Kinderklinik; Düsseldorf, Uni-Kinderklinik; Eberswalde, Klinikum Barnim Werner Forßmann-Innere; Erfurt, Kinderklinik; Erlangen, Uni-Kinderklinik; Essen, Elisabeth Kinderklinik; Essen, Uni-Kinderklinik; Esslingen, Städtische Kinderklinik; Eutin, Kinderklinik; Eutin, St.-Elisabeth Innere; Frankfurt, Uni-Klinik Innere; Freiburg, Uni-Kinderklinik; Friedberg, Innere Klinik; Friedrichshafen, Kinderklinik; Fulda, Innere Medizin; Fulda, Kinderklinik; Fürth, Kinderklinik; Gaissach, Kinder-Fachklinik; Garmisch-Partenkirchen, Kinderklinik; Gelnhausen, Kinderklinik; Gelsenkirchen, Kinderklinik Marienhospital; Gießen, Uni-Kinderklinik; Göppingen, Kinderklinik am Eichert; Görlitz, Städtische Kinderklinik; Göttingen, Uni-Kinderklinik; Hachenburg, Kinderpraxis; Hagen, Kinderklinik; Halle, Uni-Kinderklinik; Halle-Dölau, Städtische Kinderklinik; Hamburg, Altonaer Kinderklinik; Hamburg, Kinderklinik Wilhelmstift; Hamburg-Nord, Kinderklinik Heidberg; Hamm, Kinderklinik; Hanau, Kinderklinik; Hanau, St. Vincenz - Innere; Hannover, Henriettenstift - Innere; Hannover, Kinderklinik MHH; Hannover, Kinderklinik auf der Bult; Heidelberg, Uni-Kinderklinik; Heidenheim, Kinderklinik; Heilbronn, Innere Klinik; Herdecke, Kinderklinik; Herford, Kinderklinik; Heringsdorf, Inselklinik; Hermeskeil, Kinderpraxis; Herten, St. Elisabeth Innere Medizin; Herzberg, Kreiskrankenhaus Innere; Hildesheim, Innere; Hildesheim, Kinderarztpraxis; Hildesheim, Kinderklinik; Hinrichsegen-Bruckmühl, Diabetikerjugendhaus; Homburg, Uni-Kinderklinik Saarland; Idar Oberstein, Innere; Itzehoe, Kinderklinik; Jena, Uni-Kinderklinik; Kaiserslautern, Westpfalzklinikum Kinderklinik; Karlsburg, Diabetesfachklinik ; Karlsruhe, Städtische Kinderklinik; Kassel, Kinderklinik Park Schönfeld; Kassel, Städtische Kinderklinik; Kaufbeuren, Innere Medizin; Kempen, Heilig Geist - Innere; Kiel, Städtische Kinderklinik; Koblenz, Kemperhof 1. Med. Klinik; Koblenz, Kinderklinik Kemperhof; Konstanz, Innere Klinik; Krefeld, Innere Klinik; Köln, Uni-Kinderklinik; Landshut, Kinderklink; Leipzig, Uni-Kinderklinik; Leverkusen, Kinderklinik; Lindenfels, Luisenkrankenhaus Innere; Lingen, Kinderklinik St. Bonifatius; Lippstadt, Evangelische Kinderklinik; Ludwigsburg, Innere Medizin; Ludwigsburg, Kinderklinik; Ludwigshafen, Kinderklinik St.Anna-Stift; Lübeck, Uni-Kinderklinik; Lübeck, Uni-Klinik Innere Medizin; Lüdenscheid, Kinderklinik; Magdeburg, Uni-Kinderklinik; Mainz, Uni-Kinderklinik; Mannheim, Innere; Mannheim, Uni-Kinderklinik; Marburg, Uni Innere; Marburg, Uni-Kinderklinik; Mechernich, Kinderklinik; Memmingen, Kinderklinik; Merzig, Kinderklinik; Minden, Kinderklinik; Moers, Kinderklinik; Mutterstadt, Kinderarztpraxis; Mölln, Reha-Klinik Hellbachtal; Mönchengladbach, Kinderklinik Rheydt Elisabethkrankenhaus; München, von Haunersche Kinderklinik; München-Harlaching, Kinderklinik; München-Schwabing, Kinderklinik; Münster, St. Franziskus Kinderklinik; Münster, Uni-Kinderklinik; Münster, pädiat. Schwerpunktpraxis; Nagold, Kreiskrankenhaus Innere; Neuburg, Kinderklinik; Neunkirchen, Kinderklinik Kohlhof; Neuss, Lukaskrankenhaus Kinderklinik; Neuwied, Kinderklinik Elisabeth; Nidda Bad Salzhausen, Innere; Nidda Bad Salzhausen, Innere-1; Nürnberg, Cnopfsche Kinderklinik; Nürnberg, Kinderklinik Klinikum Süd; Oberhausen, Innere; Oberhausen, Kinderklinik; Oberhausen, Kinderpraxis Bachran; Offenbach/Main, Kinderklinik; Offenburg, Kinderklinik; Oldenburg, Kinderklinik; Osnabrück, Kinderklinik; Paderborn, St. Vincenz Kinderklinik; Passau, Kinderarztpraxis Handwerker; Passau, Kinderklinik; Pforzheim, Kinderklinik; Rastatt, Gemeinschaftspraxis; Rastatt, Kreiskrankenhaus Innere; Ravensburg, Kinderklink St. Nikolaus; Recklinghausen, Dialysezentrum Innere; Regensburg, Kinderklinik St. Hedwig; Remscheid, Kinderklinik; Rendsburg, Kinderklinik; Rheine, Mathiasspital Kinderklinik; Rosenheim, Innere Medizin; Rosenheim, Kinderklinik; Rostock, Uni-Kinderklinik; Rostock, Universität Innere Medizin; Rotenburg/Wümme, Kinderklinik; Saaldorf-Surheim, Diabetespraxis; Saalfeld, Thüringenklinik Kinderklinik; Saarbrücken, Kinderklinik Winterberg; Saarlouis, Kinderklinik; Scheidegg, Reha-Kinderklinik Maximilian; Schw. Gmünd, Margaritenhospital Kinderklinik; Schweinfurt, Kinderklinik; Schwerin, Kinderklinik; Siegen, Kinderklinik; Singen, Hegauklinik Kinderklinik; Sinsheim, Innere; Spaichingen, Innere; Stade, Kinderklinik; Stolberg, Kinderklinik; Stuttgart, Olgahospital Kinderklinik; Suhl, Kinderklinik; Sylt, Rehaklinik; Traunstein, Praxis Dr. Voll; Trier, Kinderklinik der Borromäerinnen; Tübingen, Uni-Kinderklinik; Ulm, Uni-Kinderklinik; Vechta, Kinderklinik; Viersen, Kinderklinik; Waiblingen, Kinderklinik; Waldshut, Kinderpraxis Biberbau; Weiden, Kinderklinik; Weingarten, Kinderarztpraxis; Wetzlar, Praxis Klewer/Teichner; Wetzlar/Braunfels, Innere; Wiesbaden, Horst-Schmidt-Kinderkliniken; Wiesbaden, Kinderklinik DKD; Wilhelmshafen, St. Willehad Innere; Worms, Kinderklinik; Wuppertal, Kinderklinik.

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Authors and Affiliations

  1. Pediatric Diabetes Unit, Department of Pediatric and Adolescent Medicine, Saarland University Hospital, Homburg/Saar, Germany

    Tilman Rohrer & Eva Stierkorb

  2. Department of Applied Information Processing (SAI), University of Ulm, Ulm, Germany

    Matthias Grabert

  3. Pediatric Endocrinology and Diabetes Unit, Department of General Pediatrics, Children’s Hospital, University of Kiel, Kiel, Germany

    Paul-Martin Holterhus

  4. Pediatric Diabetes Unit, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany

    Thomas Kapellen

  5. Pediatric Diabetes Unit, Hospital for Children and Adolescents, University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany

    Ina Knerr

  6. Endocrinology Clinic, Hospital for Children and Adolescents, University of Rostock, Rostock, Germany

    Monika Mix

  7. Department of Epidemiology, University of Ulm, Ulm, Germany

    Reinhard W. Holl

  8. Department of Pediatrics and Neonatology, Saarland University Hospital, Kirrberger Str. 1, Geb. 9, 66421, Homburg/Saar, Germany

    Tilman Rohrer

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  1. Tilman Rohrer
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  2. Eva Stierkorb
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  3. Matthias Grabert
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  8. Reinhard W. Holl
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Rohrer, T., Stierkorb, E., Grabert, M. et al. Delayed menarche in young German women with type 1 diabetes mellitus: recent results from the DPV diabetes documentation and quality management system. Eur J Pediatr 167, 793–799 (2008). https://doi.org/10.1007/s00431-007-0590-0

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