According to the Centers for Disease Control and Prevention, over 29 million Americans have diabetes. What’s more alarming is that 25 percent of those 29 million aren’t aware that they’re diabetic. In addition, 86 million others have prediabetes. Well-known risk factors of diabetes — family history, excess weight and a sedentary lifestyle — apply to both sexes. But doctors are now investigating how some female-specific conditions, such as polycystic ovary syndrome and pre-eclampsia and gestational diabetes in pregnant women, are linked to the development of the disease. We spoke with Dr. Andrea Dunaif, the chief of the endocrinology, diabetes and bone disease division at Mount Sinai Sinai Health System, about why some women aren’t diagnosed early enough, and how patients can talk to their doctors.
What predisposes a woman to becoming diabetic?
Women who've had gestational diabetes [a condition that can develop during pregnancy and often disappears after delivery] are really substantially at increased risk to develop the adult form of diabetes, type 2 diabetes. That's one incredibly important group of women who need to know that they should be monitored for that.
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Why would a woman receiving prenatal care not be aware of that risk?
Frequently, they fall between the cracks because they're young and usually they're getting their complete healthcare from their gynecologist, and the gynecologist may not be aware of this longer-term diabetes risk.
Once women are assessed, what are the next steps?
One option is just the lifestyle modification, losing about 5 to 10 percent of body weight and moderate exercise, such as half an hour of walking five days a week. It's not a massive intervention that's hard for people to do. If that doesn't work, we would even prescribe a medication called Metformin, which is a diabetes medication. It's also been shown in the setting of prediabetes to reduce the risk for progression to type 2 diabetes by about 40%.
Polycystic ovary syndrome can also put women at risk.
It's really a hormone imbalance. These women typically have menses fewer than six to eight times per year. Increased hair growth is the most typical symptom. These women often have difficulties with weight management. The diagnosis is often missed because there's, unfortunately, not a lot of awareness of it. Therefore, women with it aren't getting the appropriate testing to see if they're at risk for diabetes frequently.
How can women talk to their gynecologists about this?
I think a conversation that every woman should have with their primary care physician [is] "Do I have risk factors for diabetes? Should I have screenings earlier, or should I have more intensive screenings?" If you are having less frequent periods, that's not normal [and can be] a sign of a hormonal imbalance. It's usually PCOS. It can sometimes be other conditions, but all of them have health risks associated with them. If you have that, you need to have that evaluated and get a diagnosis. You do not need to be told you'll grow out of it or you're just overweight. I think women need to be their own advocates to make sure that they're getting the hormonal testing for it and an answer.