The risk for developing diabetes may be increased in postmenopausal women who experience hot flashes accompanied by night sweats, according to findings from the Women’s Health Initiative.
Kristen E. Gray, PhD, a health services researcher and epidemiologist at VA Puget Sound Health Care System and the department of health services at the University of Washington School of Public Health in Seattle, and colleagues evaluated data from 150,007 postmenopausal women aged at least 50 years participating in WHI from 1993 to 2014 to determine the associations between vasomotor symptom characteristics — including severity (mild, moderate or severe), type (hot flashes/night sweats), timing (early premenopausal or perimenopausal/late postmenopausal) and duration — and incident diabetes. Mean follow-up duration was 13.1 years.
At baseline, 101,220 participants had no vasomotor symptoms, and most were white (87.1%) and aged 60 to 69 years (47.1%); 48,787 had vasomotor symptoms, and most were white (77.1%) and aged 50 to 59 years (46.5%).
During follow-up, there were 18,316 incident cases of diabetes for an overall incidence of 9.3 per 1,000 person-years of follow-up: 8.4 per 1,000 person-years among participants without baseline vasomotor symptoms and 11.3 per 1,000 among participants with baseline vasomotor symptoms. Diabetes risk increased by 18% in participants reporting any vasomotor symptoms compared with those reporting no symptoms (HR = 1.18; 95% CI, 1.14-1.22).
The risk for diabetes was 50% higher among those with severe vasomotor symptoms (HR = 1.48; 95% CI, 1.35-1.62), 29% higher with moderate symptoms (HR = 1.29; 95% CI, 1.22-1.36) and 13% higher with mild symptoms (HR = 1.13; 95% CI, 1.08-1.17) compared with no vasomotor symptoms.
The risk for diabetes was increased in participants who reported night sweats alone (HR = 1.2; 95% CI, 1.13-1.26) or in combination with hot flashes (HR = 1.22; 95% CI, 1.17-1.27) and by 8% in those reporting hot flashes only vs. no vasomotor symptoms.
The risk for diabetes increased with every increase in night-sweat severity whether reported without hot flashes (HR = 1.16; 95% CI, 1.12-1.21), with mild hot flashes (HR = 1.13; 95% CI, 1.09-1.17) or with moderate/severe hot flashes (HR = 1.1; 95% CI, 1.04-1.16). The risk for diabetes increased by 5% with every increase in reported hot flash severity.
Compared with participants reporting no vasomotor symptoms, participants reporting late symptoms had an increased risk for diabetes regardless of whether they also experienced early symptoms (HR = 1.16; 95% CI, 1.11-1.22) or only late symptoms (HR = 1.12; 95% CI, 1.07-1.18). No association was observed between the risk for diabetes and early symptoms only.
Every 5-year increase in vasomotor symptom duration increased the risk for diabetes by 4%.
“Mechanisms linking [vasomotor symptoms] and diabetes are unclear and should be the focus of future investigations,” the researchers wrote. “Although findings related to sleep disturbance may provide some preliminary clues, efforts to elucidate the underlying biological pathways are a critical next step. Regarding clinical implications of this work, given that nearly 60% of U.S. women seek care for treatment of [vasomotor symptoms], the menopause transition may be an optimal time for clinicians to discuss future diabetes risk and assist patients in decision-making around symptom management.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.