{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:29:52Z","timestamp":1792891792562,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed\/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.<\/jats:p>","DOI":"10.3390\/jpm13020374","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T02:07:44Z","timestamp":1676945264000},"page":"374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0483-7126","authenticated-orcid":false,"given":"Elena","family":"Gamarra","sequence":"first","affiliation":[{"name":"Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), 6501 Bellinzona, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-4937","authenticated-orcid":false,"given":"Pierpaolo","family":"Trimboli","sequence":"additional","affiliation":[{"name":"Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), 6501 Bellinzona, Switzerland"},{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana (USI), 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"ref_1","first-page":"51","article-title":"Influence of menstruation on carbohydrate tolerance in diabetes mellitus","volume":"47","author":"Cramer","year":"1942","journal-title":"Can. Med. Assoc. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1177\/1932296819899394","article-title":"Continuous glucose monitoring devices: Past, present, and future focus on the history and evolution of technological innovation","volume":"15","author":"Didyuk","year":"2021","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.2337\/diacare.22.9.1462","article-title":"Insulin sensitivity indices obtained from oral glucose tolerance testing: Comparison with the euglycemic insulin clamp","volume":"22","author":"Matsuda","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_4","first-page":"E667","article-title":"Quantitative estimation of insulin sensitivity","volume":"236","author":"Bergman","year":"1979","journal-title":"Am. J. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4103\/2230-8210.146874","article-title":"Assessment of insulin sensitivity\/resistance","volume":"19","author":"Gutch","year":"2015","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"108359","DOI":"10.1016\/j.diabres.2020.108359","article-title":"Estimated insulin sensitivity in type 1 diabetes adult using clinical and research biomarkers","volume":"167","author":"Januszewski","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/j.1464-5491.1995.tb00462.x","article-title":"Day-to-day variation of insulin sensitivity in patients with type 1 diabetes: Role of gender and menstrual cycle","volume":"12","author":"Moberg","year":"1995","journal-title":"Diabet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1464-5491.1993.tb00096.x","article-title":"Perimenstrual symptoms in women with diabetes mellitus and the relationship to diabetic control","volume":"10","author":"Cawood","year":"1993","journal-title":"Diabet. Med."},{"key":"ref_9","first-page":"105","article-title":"Menstrual cyclicity, sleep efficiency and unplanned physical activity: Glycemic response in women suffering from type 1 diabetes mellitus","volume":"19","author":"Gamarra","year":"2016","journal-title":"J. AMD"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1210\/clinem\/dgac443","article-title":"Ambulatory glucose profile according to different phases of the menstrual cycle in women living with type 1 diabetes","volume":"107","author":"Tatulashvili","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/0020-7489(94)90079-5","article-title":"Metabolic control, food intake and mood during the menstrual cycle in patients with insulin-dependent diabetes","volume":"31","author":"Lundman","year":"1994","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1177\/1932296815608400","article-title":"Fluctuation of hyperglycemia and insulin sensitivity are linked to menstrual cycle phases in women with type 1 diabetes","volume":"9","author":"Brown","year":"2015","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1089\/1520915041705875","article-title":"Cyclic changes in glycemia assessed by continuous glucose monitoring system during multiple complete menstrual cycles in women with type 1 diabetes","volume":"6","author":"Goldner","year":"2004","journal-title":"Diabetes Technol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1002\/(SICI)1096-9136(199606)13:6<525::AID-DIA123>3.0.CO;2-D","article-title":"Self-reported changes in capillary glucose and insulin requirements during the menstrual cycle","volume":"13","author":"Lunt","year":"1996","journal-title":"Diabet. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"213","DOI":"10.2337\/diacare.15.2.213","article-title":"Alteration in glucose metabolism during menstrual cycle in women with IDDM","volume":"15","author":"Widom","year":"1992","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1464-5491.1990.tb01309.x","article-title":"Effect of phase of menstrual cycle on insulin sensitivity, peripheral blood flow and cardiovascular responses to hyperinsulinaemia in young women with type 1 diabetes","volume":"7","author":"Macdonald","year":"1990","journal-title":"Diabet. Med."},{"key":"ref_17","first-page":"b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMI"},{"key":"ref_18","unstructured":"(2022, November 16). Study Quality Assessment Tools | NHLBI, NIH, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.medcli.2015.11.044","article-title":"Glycemic changes during menstrual cycles in women with type 1 diabetes","volume":"146","author":"Herranz","year":"2016","journal-title":"Med. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1089\/dia.2022.0154","article-title":"Insulin replacement across the menstrual cycle in women with type 1 diabetes: An in-silico assessment of the need for ad-hoc technology","volume":"24","author":"Diaz","year":"2022","journal-title":"Diabetes Technol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1089\/dia.2021.0431","article-title":"Insulin delivery and glucose variability throughout the menstrual cycle on closed loop control for women with type 1 diabetes","volume":"24","author":"Levy","year":"2022","journal-title":"Diabetes Technol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.2337\/dc12-2248","article-title":"The effect of the menstrual cycle on glucose control in women with type 1 diabetes evaluated using a continuous glucose monitoring system","volume":"36","author":"Barata","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1089\/dia.2006.0004","article-title":"Mentrual cycle effects on insulin sensitivity in women with type 1 diabetes: A pilot study","volume":"9","author":"Trout","year":"2007","journal-title":"Diabetes Technol. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S2213-8587(22)00319-9","article-title":"Continuous glucose monitoring and metrics for clinical trials: An international consensus statement","volume":"1","author":"Battelino","year":"2023","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_25","first-page":"201","article-title":"Changes in oral glucose tolerance during normal menstrual cycle","volume":"57","author":"Roy","year":"1971","journal-title":"J. Indian Med. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1136\/bmj.2.5604.528","article-title":"Changes in oral glucose tolerance during the menstrual cycle","volume":"2","author":"Jarrett","year":"1968","journal-title":"Br. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/S0002-9378(87)80365-4","article-title":"Influence of the menstrual cycle on glucose tolerance and insulin secretion","volume":"157","author":"Bonora","year":"1987","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.1471-0528.1975.tb02216.x","article-title":"Carbohydrate metabolism in the menstrual cycle","volume":"82","author":"Cudworth","year":"1975","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/S0002-9378(16)34546-X","article-title":"Menstrual cycle carbohydrate metabolism","volume":"99","author":"Spellacy","year":"1967","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1210\/jcem-59-2-350","article-title":"Insulin sensitivity during the menstrual cycle","volume":"59","year":"1984","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1210\/jcem-64-1-74","article-title":"Insulin action does not change during the menstrual cycle in normal women","volume":"64","author":"Toth","year":"1987","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0015-0282(16)60842-7","article-title":"Menstrual cyclicity has a profound effect on glucose homeostasis","volume":"52","author":"Diamond","year":"1989","journal-title":"Fertil. Steril."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.2337\/diab.34.11.1092","article-title":"Importance of glucose per se to intravenous glucose tolerance. Comparison of the minimal-model prediction with direct measurements","volume":"34","author":"Ader","year":"1985","journal-title":"Diabetes"},{"key":"ref_34","first-page":"3","article-title":"Advances in diabetes for the millennium: Diabetes in women","volume":"6","author":"Jovanovic","year":"2004","journal-title":"MedGenMed"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1210\/jcem-47-6-1387","article-title":"Insulin receptors during the menstrual cycle in normal women","volume":"47","author":"Fusco","year":"1978","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1210\/jcem-50-2-246","article-title":"Differences in insulin receptors between men and menstruating women and influence of sex hormones on insulin binding during the menstrual cycle","volume":"50","author":"Bertoli","year":"1980","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1210\/jcem-52-5-937","article-title":"Insulin binding in human pregnancy: Comparisons to the postpartum, luteal and follicular states","volume":"52","author":"Moore","year":"1981","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_38","first-page":"1","article-title":"Correlation between glycemic control and menstruation in diabetic adolescents","volume":"45","author":"Schroeder","year":"2000","journal-title":"J. Reprod. Med."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/2\/374\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:37:42Z","timestamp":1760121462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/2\/374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,20]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jpm13020374"],"URL":"https:\/\/doi.org\/10.3390\/jpm13020374","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,20]]}}}