Menopause raises Type 1 diabetes complication risks: study

Private drug and supplemental benefits plans in Alberta must be billed before government-sponsored coverage as of October 1, under Bill 11, according to the Health Statutes Amendment Act, 2025 (No. 2). 

Section 77 of the Act prohibits payment of a drug and supplemental benefit under a public plan where the member is entitled to the same or equivalent benefit from an alternative payor.  

A public plan may pay only after the member has submitted a claim to that payor and the payor has paid none of the amount claimed, paid only part of it, deemed the member not entitled, or denied the claim.  

Any public payment must not exceed the portion the alternative payor did not pay.  

Section 74(2) states that a plan established for the employees of a municipality or of the Government of Alberta is a private plan. 

Coverage for Seniors and Non-Group Coverage become last payor for prescription drugs, land ambulance services, clinical psychological services, home nursing care, chiropractic services, prosthetic and orthotic benefits, mastectomy prosthesis and hospital accommodation, according to Alberta Blue Cross, which administers both programs for the province. 

Alberta Blue Cross published an example using a $100 claim for a drug on the Alberta Drug Benefit List, for a member over 65 holding both a Retiree plan and Coverage for Seniors. 

Before October 1, Coverage for Seniors paid $70 and the Retiree plan paid the remaining $30.  

Under the new order the Retiree plan pays $30 first, at 30 percent to a maximum of $35 per prescription, and Coverage for Seniors pays the remaining $70. 

Members who coordinate an employer or personal plan with a Government of Alberta-sponsored plan may reach their private plan's annual maximum sooner and carry out-of-pocket costs for expenses covered by neither plan. 

Health spending accounts are not included in the legislation. 

Section 78(1) bars an employer that establishes, maintains in force or renews an employer-sponsored drug and supplemental benefits plan from including a provision allowing it, solely on the basis of a member's age, to terminate the member's membership or to terminate, reduce or modify the member's benefits.  

Section 79 renders any such provision of no force or effect. 

Section 80 allows the Minister to order a contravening employer to reinstate a member on the terms that applied before termination, restore benefits that were terminated, reduced or modified, and reimburse the member for amounts paid during the period the coverage was withdrawn.  

Section 81 allows the Minister to apply to the Court of King's Bench where an employer does not comply. 

Alberta Blue Cross is removing the age limit on drugs and all extended health benefits on standard insured plans that currently carry termination ages, effective October 1.  

Active employees already terminated on the basis of age have to be added back.  

Dental, life insurance, disability, travel insurance and spending accounts may still change at term age depending on the employer.  

The insurer told plan sponsors to review eligibility rules and contract wording, assess plan design for savings opportunities, and consider the budgetary impact. 

Randy Howden, a pharmacist and owner of The Medicine Shoppe in Calgary, told CTV News that the private plan provider expects premium increases in the next few years. 

Howden said the provider links the increases to more use of private plans. 

Costs previously paid first by the public plan are now charged to private insurance, Chris Gallaway with Friends of Medicare told CTV News.  

Gallaway said premiums will rise or coverage will be cut, and he expects employers, workers, and retirees to face higher costs. 

Bill 11 does not freeze premiums or limit how much plan costs can increase, CTV News reported. 

The Ministry of Primary and Preventative Health Services told CTV News the changes "align Alberta with other provinces and help ensure public coverage remains available for those who need it most."  

The ministry did not explain how co-payments would be calculated or address premium increases and costs to employers and seniors, CTV News reported. 

Postmenopausal women living with Type 1 diabetes in Canada carried roughly three times the risk of cardiovascular disease and more than double the risk of retinopathy, neuropathy and falls compared with premenopausal women in the same age band.  

A cross-sectional analysis of the BETTER registry, published in the September issue of Diabetes Research and Clinical Practice, reported a mean age of 55.1 years in the postmenopausal group, 46.1 years in the premenopausal group, and 49.0 years at menopause.  

BETTER is a Canadian patient-oriented registry that has collected self-reported data from people living with Type 1 diabetes since 2019.  

After overlap weighting for age, diabetes duration, BMI, number of pregnancies, and education, postmenopausal status carried risk ratios of 3.31 (95 percent confidence interval 1.07 to 10.23) for cardiovascular disease, 2.64 (1.73 to 4.03) for falls in the previous year, 2.22 (1.17 to 4.21) for neuropathy, and 2.20 (1.15 to 4.23) for retinopathy.  

Moderate-to-severe depressive symptoms, defined as a PHQ-9 score of 10 or higher, carried a risk ratio of 1.48 (1.01 to 2.17).  

"What we found (ultimately) was that there were several things that were worse for women after menopause than before menopause," study co-author Jane Yardley of the Montreal Clinical Research Institute in Montreal told CTV News.  

Insulin doses, HbA1c, hypoglycemia frequency and fear of hypoglycemia did not differ by menopausal status in the weighted models.  

Postmenopausal women had lower odds of reporting a current antihypertensive prescription (risk ratio 0.57, 0.38 to 0.84) and a current lipid-lowering prescription (0.68, 0.54 to 0.86), and lower odds of elevated diabetes distress on the DDS-17 (0.80, 0.68 to 0.95).   

The authors write that prescription prevalence did not differ significantly before weighting, and that the association emerged after adjustment.  

In the unweighted comparison, postmenopausal women reported lower perceived social support on the MOS scale (24.6 versus 27.3 out of 35, p = 0.006) and a higher sleep disturbance component score (19.5 versus 18.1, p = 0.016).  

Some of these risks may not have received enough attention, Yardley said in comments reported by CTV News.   

Yardley said mental health risks stand out because they cannot be measured physically.  

The cardiovascular disease association rested on 10 events and did not persist in either sensitivity analysis, and the study describes it as exploratory.   

Falls, retinopathy and the two prescription outcomes were the most consistent across sensitivity analyses.   

The neuropathy association appeared only in the primary model.  

Menopausal status, cardiovascular disease, retinopathy, neuropathy, falls and hypoglycemia frequency were all self-reported rather than medically confirmed.   

The cross-sectional design precludes causal inference, and with a mean age gap of approximately nine years between the groups, the authors state the associations should not be read as independent effects of menopause.   

Data on hormone therapy use was unavailable, and the overlap-weighted effective sample size was 75.2, or 35.6 percent of the nominal 211 participants.