Persistent Menopausal Symptoms Linked to Higher Diabetes Risk, reveals study

The SWAN study was a long-term prospective study of 2761 midlife women from a diverse racial and ethnic backgrounds of the United States. At baseline, the women studied were at intermediate levels between being premenopausal and being at an early stage of perimenopause and followed for as long as up to 13 annual visits. Vasomotor symptoms (VMS) frequency was determined based on participants' self-reports regarding frequency of hot flashes and night sweats and significantly varies in the population across studies. Women already diagnosed with diabetes, using hormone therapies, or lacking adequate follow-up data were excluded for the analysis, thereby providing a clearly defined cohort that could be followed with respect to VMS trajectories and risk of incident diabetes.

The number of VMS was assessed at each follow-up visit in the SWAN study, and diabetes status was determined by use of medication for antidiabetic use, repeated high fasting glucose (≥126 mg/dL), or self-reported diabetes with high fasting glucose. The discrete-time hazard models were used to calculate hazard ratios (HRs) of diabetes associated with different frequencies and patterns of VMS. Other covariates tested were demographics and lifestyle factors such as age, race/ethnicity, education, BMI, physical activity, smoking, alcohol intake, and menopausal stage.

• At baseline, 28% of women reported VMS 1-5 days/wk, 10% reported VMS 6 or more days/wk, and 62% reported VMS 0 days/wk.

• At study completion, 338 of the 2768 participants (12.2%) had developed diabetes.

 •The incidence of frequent VMS was associated with an increased risk of diabetes (45%; HR, 1.45; 95% CI, 1.11-1.95), and women reporting infrequent VMS were at a 30% higher risk (HR, 1.30; 95% CI, 1.00-1.70) compared with women without VMS.

• The four major patterns of VMS trajectories across participants were classified into four categories: consistently low VMS probability (26%), persistently high VMS probability (31%), early onset with a gradual decline (25%), and late onset with a gradual increase (19%).

• Women with the persistently high VMS patterns had a 50% higher risk of diabetes compared with women with consistently low VMS probability (HR, 1.50; 95% CI, 1.12-2.02).

The persistence of VMS during menopause may thus be considered a marker of the risk of T2DM, thereby identifying the at-risk population for diabetes prevention. These findings further suggest to health care providers the necessity of considering VMS patterns while making assessments regarding metabolic health in menopausal women and further reinforce the need for targeted preventive care and lifestyle management among women with persistent VMS.

Reference:

Hedderson, M. M., Liu, E. F., Lee, C., El Khoudary, S. R., Gold, E. B., Derby, C. A., & Thurston, R. C. (2024). Vasomotor symptom trajectories and risk of incident diabetes. JAMA Network Open, 7(10), e2443546. https://doi.org/10.1001/jamanetworkopen.2024.43546