Vasomotor symptoms associated with diabetes risk

Vasomotor symptoms associated with diabetes risk | Image Credit: © toa555 - © toa555 - stock.adobe.com.

There are associations of frequent vasomotor symptoms (VMS) and vasomotor symptom trajectory with diabetes risk, according to a recent study published in JAMA Network Open.¹

VMS, defined as hot flashes and night sweats, frequently occur during menopause. Recently, data has indicated a potential association between VMS and increased cardiometabolic risk during and after menopause.

Certain health complications have been linked to VMS during menopause, including an increased risk of Alzheimer’s disease (AD).² In a study evaluating this association based on biomarkers, significantly reduced Aβ42 and Aβ40 was found in patients with objectively measure VMS. This indicated a positive correlation.

Significant variations in the frequency and temporal patterns of VMS have been observed between women, with data about whether VMS trajectories impact type 2 diabetes (T2D) risk lacking.¹ Therefore, investigators conducted a study to determine the association between VMS frequency and trajectory with incident T2D.

The Study of Women’s Health Across the Nation (SWAN) was a prospective cohort study including premenopausal or early perimenopausal women in the United States. Participants were evaluated across up to 13 annual follow-up visits.

Exclusion criteria included diabetes or exogenous hormone use at baseline, lack of at least 3 follow-up visits before diabetes diagnosis, and missing VMS data. Information reported at follow-up visits included the frequency of hot flashes and night sweats during the prior 2 weeks.

Diabetes was determined based on the use of antidiabetic medication, a fasting glucose of 126 mg/dL or greater without steroid use at 2 consecutive visits, or 2 visits with self-reported diabetes and 1 with a fasting glucose of 126 mg/dL or greater. Discrete-time hazard models were used to evaluate the link between VMS and incident diabetes.

Covariates included time and site, race and ethnicity, baseline age and educational attainment, time-varying body mass index, physical activity, smoking status, alcohol consumption, and menopausal transition (MT) stage. Data evaluation occurred between January 2021 and June 2024.

There were 2761 midlife SWAN participants at baseline aged a mean 46 years. Of participants, 27% were Black, 9.6% Japanese, and 49% White. A VMS frequency of 1 to 5 days over a 2-week period was reported by 28%, 6 or more days per week by 10%, and no VMS by 62%. Diabetes incidence during follow-up occurred in 12.2%.

An association was reported between more frequent time-varying VMS and incident diabetes, with a hazard ratio (HR) of 1.45 among patients with frequent VMS vs those with relative to no VMS. For patients with infrequent VMS, the HR was 1.30.

VMS trajectories included consistently low probability of VMS in 26% of patients, persistently high probability in 31%, early-onset initial high probability decreasing over time in 25%, late-onset initial low probability increasing over time in 19%, and unknown in 0.2%.

The risk of diabetes was significantly increased from persistently high VMS vs consistently low, with an HR of 1.50. Similar results were reported between hot flashes and night sweats.

These results indicated a 50% increased risk of diabetes among patients with frequent VMS or a trajectory of persistent VMS. Investigators concluded, “women with frequent and/or persistent VMS over the MT may represent a high-risk group to target for diabetes prevention.”

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. Krewson C. Nighttime vasomotor symptoms linked to Alzheimer's risk. Contemporary OB/GYN. March 19, 2024. Accessed November 5, 2024. https://www.contemporaryobgyn.net/view/nighttime-vasomotor-symptoms-linked-to-alzheimer-s-risk