Vasomotor symptom frequency linked to diabetes risk

Frequent or potentially persistent vasomotor symptoms (VMS) are associated with a 50% increased risk of women developing diabetes, according to new findings from a prospective cohort analysis.

A team of US investigators reported findings from new research showing women with frequent and/or persistent VMS during menopause may be predisposed to a higher risk of developing diabetes. Given the aging population, clinicians should consider such a correlative risk when treating VMS.

Led by Monique M. Hedderson, PhD, of the division of research at Kaiser Permanente Northern California, investigators assessed the associations of VMS frequency and trajectories with incident type 2 diabetes (T2D) in women undergoing menopause transition. Their cohort was derived from the Study of Women’s Health Across the Nation (SWAN).

As they noted, vasomotor symptoms including night sweats and hot flashes are “the hallmark signs of menopause.” Relevant research has distinguished a potential link between VMS and increased cardiometabolic risks in women during and after menopausal transition. Interestingly, it has been established that women with early-age diabetes are more likely to enter menopause transition earlier than most.

“While most women experience VMS, the frequency and the temporal patterns vary dramatically across subgroups of women,” the team wrote. “Past studies examined the association of VMS at 1 time point with diabetes; thus, it remains unknown whether VMS trajectories across the menopausal transition are associated with risk of T2D.”

The SWAN prospective cohort included US women who were premenopausal or early perimenopausal at baseline; participants were assessed at ≤13 annual follow-up visits across 7 clinical sites. At each follow-up, participants reported their rate of VMS in the past 2 weeks, including hot flashes and/or night sweats. Diabetes prevalence at each visit was defined by any use of antidiabetic medication, 2 consecutive visits with fasting glucose ≥126 mg/dL while receiving steroids, or 2 visits including self-reported diabetes.

Hedderson and colleagues assessed for links between VMS and VMS trajectories with incidence diabetes via discrete-time hazard ratio (HR) models. Models were adjusted for time and site, as well as self-reported race and ethnicity, baseline age, educational attainment, body mass index (BMI), physical activity, smoking status, alcohol consumption and menopausal transition stage.

The cohort included 2761 participants at baseline. Patients were ethnically diverse, with 49% being White, 27% Black and 9.6% Japanese. Mean patient age was 46 years old.

Approximately one-fourth (28%) of patients reported VMS at 1 – 5 days every 2 weeks; 10% reported symptoms ≥6 days per week, and 62% reported no VMS at all. Investigators observed diabetes in 338 (12.2%) patients during follow-up.

The team observed that VMS was linked with a ≤45% increased risk of incident diabetes in women (frequent VMS HR, 1.45; 95% CI, 1.11 – 1.95), though the risk was slightly less for those with infrequent VMS (HR, 1.30; 95% CI, 1.00 – 1.70).

Investigators further identified 4 trajectories of VMS status: consistently low probability; persistently high probability; early onset-initial high probability that decreased over time; and late onset-initial low probability that increased over time. They found that women with persistently high VMS had an increased risk of diabetes versus those with consistently low VMS (HR, 1.50; 95% CI, 1.12 – 2.02).

Indeed, investigators concluded frequent VMS or a trajectory of persistent VMS were both linked to a 50% increased risk of diabetes in women entering menopause transition. They advised that women with frequent hot flashes and/or night sweats may be viable targets for diabetes preventive care.

References

1. ^{Hedderson MM, Liu EF, Lee C, et al. Vasomotor Symptom Trajectories and Risk of Incident Diabetes. JAMA Netw Open. 2024;7(10):e2443546. doi:10.1001/jamanetworkopen.2024.43546}
2. ^{Carr L. Women with diabetes at early age more likely to enter menopause early. Contemporary OB/GYN. Published January 12, 2023. https://www.contemporaryobgyn.net/view/women-with-diabetes-at-early-age-more-likely-to-enter-menopause-early}