DCB Newsletter #3/25: Menstrual cycle and insulin requirements

Research at the Diabetes Centre Berne: Focus on the menstrual cycle and insulin requirements

The Diabetes Centre Berne (DCB) is investigating the influence of hormonal fluctuations, particularly the menstrual cycle, on diabetes management. Martina Rothenbühler and Stefanie Hossmann explain how they are working with the community to collect data and gain new insights to help those affected.

Martina Rothenbühler (MR) and Stefanie Hossmann (SH), what are your roles at the Diabetes Centre Berne (DCB)?

MR: My focus is on data analysis and developing research questions. I draw on my background in biostatistics and investigate, for example, how hormonal fluctuations influence insulin requirements.

SH: I am responsible for coordinating studies at the DCB and ensuring compliance with regulatory requirements. My background as a biologist enables me to tailor these studies to the specific needs of the participants.

How did you come up with the idea to research this topic?

SH: We learned from the diabetes community, from various people living with diabetes, that there are fluctuations in diabetes management in relation to the menstrual cycle. We then began to look into the topic in more detail. We found very little on this in the mainstream scientific journals, so we decided to investigate the topic more thoroughly. There are different phases in the menstrual cycle during which hormones increase or decrease. These include, for example, the follicular phase and, at the end, the luteal phase. Ovulation takes place in between. Since all of this is closely linked to hormones, we assumed that insulin requirements are also affected.

MR: I previously worked at Ava, a femtech start-up. There, we conducted research projects that showed that the menstrual cycle has many different effects, for example in the areas of sport and osteoporosis. This sparked my interest, as insulin sensitivity may also be related to this.

Why has this topic been largely unexplored until now?

MR: One of the reasons is the so-called gender health data gap, i.e. the lack of health data on women. For a long time, women were excluded from clinical studies to avoid risks, for example in the event of pregnancy. In addition, hormonal fluctuations were considered potential confounding factors that could make general statements difficult. These aspects are not yet sufficiently anchored in research.

SH: That’s really surprising. With almost every new research topic, you realise that this is not a given.

How does the diabetes community view your efforts to investigate the link between diabetes and the menstrual cycle?

MR: We have mainly received feedback from people who already considered the topic important or saw it as a personal problem. However, we do not know how many women did not feel affected by it. For some, enthusiasm for our research was greater than their willingness to actually participate in the study. Nevertheless, many found the topic interesting and important, even if participating in a study is a hurdle.

SH: We also often received feedback that this issue is seen as a relatively minor problem and that more important issues should be addressed first. However, we take a different view. Especially when diabetes management is already at a high level, a small improvement, such as five per cent more time in the target range (time in range), can bring about a noticeable improvement. This has also been confirmed by the community.

What further goals are you pursuing with your research in this area?

MR: Our aim is to bring more data from women and non-binary people into medical research and to raise awareness of these issues. The focus is not only on time-in-range, but also on how technology should be designed in this context. For example, more is already known about the influence of gender on sport and nutrition in relation to diabetes.

SH: However, less research has been done on hormonal transition phases such as pregnancy, breastfeeding or gender reassignment.

MR: Or even the entire puberty phase. All these gender-specific phases are related to diabetes, but they are still largely unexplored. We are currently working on an editorial that highlights precisely these areas.

Why is this topic particularly relevant to the Diabetes Centre Berne?

MR: What is special about diabetes and the menstrual cycle is that there is no specific industry behind it and therefore hardly any commercial interests at stake. Our research covers the entire field of diabetes technology and is not limited to a single manufacturer. However, this also means that there is often little research funding available and we are dependent on third-party funding. As a foundation, we are therefore in a good position to conduct this research together with people with diabetes.

What specific projects are you currently working on, and what are your main goals?

MR: What I find exciting is the fact that, although there are restrictions for certain groups, many of those affected have nevertheless found their own solutions to deal with the challenges. They have developed strategies that work for them personally.

SH: We are currently working closely with the community to understand exactly where the problems lie and what needs exist. We are collecting data on the extent of the burden and the strategies that those affected have developed to cope with it. So far, we have evaluated data from the past. In the future, we would like to collect data in a targeted and forward-looking manner to get even better answers to our questions.

Thanks so much for reading, and we’ll provide you with the next episode of this series soon!

This edition was authored by Sunjoy Mathieu, Communication Manager at DCB.