Understanding the Impact of Menstruation on Diabetes Management

In this expert conversation, Anuradha Krishnan, BA, research analyst at dQ&A, previews her upcoming presentation at the 2025 American Diabetes Association Scientific Sessions on the impact of menstruation on diabetes management among individuals in the United States and EU. She discusses the need to better understand how hormonal fluctuations influence insulin sensitivity and glycemic control—particularly for those with type 1 diabetes—and highlights persistent gaps in clinical conversations, patient education, and technology design.

Additional Resource:

• Krishnan A. Examining the effects of menstruation on diabetes management among people with diabetes in the US and the EU. Abstract 1660-P. Presented at: American Diabetes Association 85th Scientific Sessions; June 20–23, 2025; Chicago, IL. https://professional.diabetes.org/scientific-sessions

TRANSCRIPTION

Anuradha Krishnan, BA: My name is Anu Krishnan. I'm a research analyst at dQ&A, which is a diabetes focused market research firm, and I will be presenting at ADA on a project titled Examining the Effects of Menstruation on Diabetes Management Among People with Diabetes in the US and the EU.

Consultant360: What are some of the key themes of the presentation?

Krishnan: You know, I think at this point in time, it's been established that hormone fluctuations can affect insulin sensitivity and blood glucose levels. But these are not addressed in clinical care to the extent that they should be. Despite this kind of measurable impact that they have, in addition to the emotional and cognitive effects of menstruation, hormonal fluctuations can also add challenges to diabetes management. Ahe end of the day, I think menstruation’s impact on diabetes is significantly under studied in research and clinical care, and so our study kind of aimed to examine these perceived effects of menstruation on diabetes management and also identify key knowledge and communication and care gaps that may be present.

C360: Why do you feel this topic is particularly relevant right now?

Krishnan: I think there is kind of growing momentum in medicine towards more personalized and gender-inclusive care, which makes this kind of a timely topic. As technology and diabetes management becomes more and more advanced, like continuous glucose monitors and automated insulin delivery system, , it's crucial to ensure that these tools are designed with hormonal fluctuations in mind.

And these happen on the cyclical cycle. And although each individual is going to experience these changes differently, I think that there is a big impact that they're having on patients with diabetes. And so understanding how menstruation affects diabetes management aligns with this shift in medicine. And we can prioritize these experiences to help improve overall diabetes care and management across both the United States and Europe as well.

I think at the end of the day, this addresses a historical blind spot. People who menstruate have often been underrepresented in diabetes research and clinical trials, and this study is one step in the right direction to help close that gap and raise awareness about an everyday challenge that deserves more attention.

C360: So what were some of the major findings of the study?

Krishnan: We found that fewer than one in five women report high satisfaction with their overall glycemic control, and these rates were notably lower in Europe than they were in the US. We also found that half of all menstruating women experience worsened glycemic control during their cycle, again, with women in Europe recording this significantly more often than those in the US, and type 1 patients in particular are disproportionately impacted by this worsened glycemic control during their cycle.

On top of this, despite its impact or menstruation impact on glycemic control, few women have ever discussed how their menstrual cycles affect their diabetes with their health care providers. And these rates of discussion were even lower among those with type 2 diabetes, specifically type 2 not on insulin.

And lastly, women with diabetes cite a significant lack of in information and guidance on the effects of hormones on their blood glucose levels, and express the need for better guidance. Technology users in particular highlighted the importance of and need for personalized systems that consider hormonal cycles and insulin needsm citing that often, they just rely on trial and error and that there is a lot of room for improvement in both technology and care.

C360: What do you feel are some of the most important takeaways for clinicians in practice from this study?

Krishnan: I think at the end of the day, our study found that menstrual cycles can and do significantly impact both glycemic control and insulin sensitivity. And there is kind of this importance of initiating the conversation. There's a lack of awareness and knowledge about these influences and about these changes. So I think that clinicians can initiate this conversation.

Keep in mind that every patient is going to have a different experience. With their hormones, with their menstrual cycles, and that is something that can be brought to the forefront of each patient's care. Many patients may not feel comfortable bringing it up themselves; simply asking about changes in glucose levels across the menstrual cycle may open the door to more effective, individualized treatment.

I think also, aside from just clinicians, speaking a little more broadly, there's a lot of growth that can happen in developing certain technologies that can be used in diabetes care. I think that there's possibilities of having automated insulin delivery system learn the different phases of a menstrual cycle and how someone's hormone levels may change during those phases, and how that, in turn, can impact their blood glucose levels.

Being able to predict these changes and correct for them in insulin doses and such could be one kind of example. Additionally, I something else that could be done is inserting a menstrual calendar alongside someone’s CGM data, so that you're able to track these changes in blood glucose levels along with your menstrual cycle, and you can figure out what works best for you and kind of plan around what changes might be happening in your blood glucose or insulin sensitivity—when you might need more insulin, when you might need less. I think that will eliminate some of the cognitive effects of this trial and error that a lot of women are kind of struggling with right now.

C360: What gaps in knowledge or areas for future research would you like to see pursued around the topic of menstruation and diabetes management?

Krishnan: Like I mentioned earlier, this is preliminary research. We've established that there are gaps in knowledge and care and technology.

And I think it can even go beyond menstruation. I think, first of all, there is still a lot of research that can be done to fully understand the kind of biological mechanisms linking these hormonal changes in insulin sensitivity, I think that's one step that can be taken. But also, speaking more broadly, in terms of kind of gender-specific diabetes care, I think that it has been established that something like polycystic ovarian syndrome has a relationship with insulin resistance. There could be a lot of research into that how menopause affects women's blood glucose and insulin sensitivity. Does that disproportionately affect type 2 versus type 1 patients? I think that that gender-specific care can be researched quite significantly.

Menopause and perimenopause are also major blind spots in diabetes research, but they affect half the population. So I think also, again, there's a question of how we can develop cycle-aware algorithms and features that can offer this better support to users.

And lastly, of course, understanding how to effectively train clinicians to incorporate menstrual health into diabetes care or hormonal changes in general is also essential, in my opinion.

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