MENOPAUSE, IDDM, AND AUTOIMMUNITY--THE FAD STUDY

家族性自身免疫和糖尿病（FAD）研究表明，桥本甲状腺炎的患病率，定义为甲状腺过氧化物酶或甲状腺球蛋白自身抗体的高滴度，在没有药物治疗的情况下TSH升高，和/或阳性病史或检查，在1型糖尿病成年女性中高于其非糖尿病姐妹篇或母亲。 这些发现表明，1型糖尿病女性患者维持免疫自身耐受的能力可能过早丧失。 这也可能反映了许多慢性并发症之一，发生在受影响的个人之间的早期年龄。 因此，人们可以预期，在1型糖尿病女性中，生物学年龄提前的其他指标可能很常见。 来自FAD研究的自我报告数据支持这一假设。 1型糖尿病女性的平均绝经年龄比非糖尿病姐妹篇的平均绝经年龄小近10岁（41.6岁对49.9岁，p <0.05）。 据我们所知，这是科学文献中关于1型糖尿病和绝经早期之间关系的第一份正式报告。 此外，这些数据对公共卫生的重要性是巨大的，必须加以确认。 鉴于心血管疾病和其他已知与长期糖尿病相关的并发症的高发病率，早期自然绝经可能会加剧1型糖尿病年轻女性心肌梗死的风险。 我们有唯一一个定义的1型糖尿病女性队列，其规模足够大，年龄适当，可以解决以下具体目标：1）为了验证一个非常重要的发现，即绝经期，定义为12个月没有排卵和FSH水平升高，与非糖尿病女性相比，1型糖尿病女性的平均年龄明显更小，2）评估1型糖尿病女性与非糖尿病女性相比，月经出血模式、绝经期月经学和绝经年龄决定因素的潜在差异，和3）评估绝经过渡期对1型糖尿病患者主要心血管疾病危险因素和自身免疫性甲状腺疾病风险的影响。糖尿病女性与非糖尿病女性相比。

The Familial Autoimmune and Diabetes (FAD) Study has shown that the prevalence of Hashimoto's thyroiditis, defined by high titres of thyroid peroxidase or thyroglobulin autoantibodies, elevated TSH in the absence of medication, and/or a positive history or exam, is higher among adult women with type 1 diabetes than their non-diabetic sisters or mothers. These findings suggest that one's ability to maintain immunological self-tolerance may be lost prematurely among women with type 1 diabetes. This may also reflect one of the many chronic complications that occur at an early age among affected individuals. One would, therefore, expect that other indicators of advanced biological age may be common among women with type 1 diabetes. Self-report data from the FAD Study support this hypothesis. The mean age at menopause for women with type 1 diabetes was nearly ten years younger than that for their non-diabetic sisters (41.6 vs. 49.9 years, p less than 0.05). To our knowledge, this is the first formal report of an association between type 1 diabetes and early menopause in the scientific literature. Moreover, the public health importance of these data, which must be confirmed, is enormous. Given the high incidence of cardiovascular disease and other complications known to be associated with long-term diabetes, an early natural menopause is likely to exacerbate the risk of myocardial infarction among young women with type 1 diabetes. We have the only defined cohort of type 1 diabetic women that is sufficiently large and of the appropriate age to address the following Specific Aims: 1) To validate the extremely important finding that menopause, defined by 12 months without menstruating and elevated FSH levels, occurs at a significantly younger average age among type 1 diabetic compared to non-diabetic women, 2) to evaluate potential differences in menstrual bleeding patterns, menopausal symptomatology and the determinants of age at menopause among type 1 diabetic compared to non-diabetic women, and 3) to evaluate the effect of the menopause transition on major cardiovascular disease risk factors and risk of autoimmune thyroid disease among type 1 diabetic compared to non-diabetic women.