- by Kristen Monaco, Staff Writer, MedPage TodayDecember 06, 2017
Menopause-related vasomotor symptoms (VMS) may heighten diabetes risk, researchers reported.
VMS, such as hot flashes and night sweats, were tied to an 18% increased risk for type 2 diabetes (95% CI 1.14-1.22), according to Kristen E. Gray, PhD, of the VA Puget Sound Health Care System in Seattle and colleagues. Independent of obesity status, VMS persisting for a longer duration were tied to a continually increasing risk for diabetes (4% per 5 years, 95% CI 1.03-1.05), they wrote in Menopause: The Journal of The North American Menopause Society.
Diabetes risk also increased with the severity of symptoms:
- Mild symptoms: hazard ratio 1.13 (95% CI 1.08-1.17)
- Moderate: HR 1.29 (95% CI 1.22-1.36)
- Severe: HR 1.48 (95% CI 1.34-1.62)
The prospective study, previously at the 2016 American Diabetes Association annual meeting, included 150,007 postmenopausal women who participated in the Women's Health Imitative, conducted at 40 centers across the U.S. All women had data regarding VMS and no history of diabetes at baseline. Menopause-related VMS were self-reported via a questionnaire, while diabetes was defined as the initial report of insulin or oral treatment.
During an average 13.1-year follow-up, there were 18,316 cases of type 2 diabetes reported among the cohort. Women who did not report experiencing VMS at baseline had a lower incidence of diabetes than women who did (8.4 per 1,000 person-years versus 11.3 per 1,000).
With regard to specific VMS, night sweats had a slightly stronger association with diabetes risk than hot flashes alone:
- Night sweats only: HR 1.20 (95% CI 1.13-1.26)
- Hot flashes only: HR 1.08 (95% CI 1.02-1.15)
- Both: HR 1.22 (95% CI 1.17-1.27)
Women who only reported experiencing VMS early on did not have an increased associated risk for type 2 diabetes (HR 0.99, 95% CI 0.95-1.04). However, those who only reported late-onset symptoms, or who experienced early and late symptoms, did have significantly associated risks (HR 1.12, 95% CI 1.07-1.18; HR 1.16, 1.11-1.22, respectively).
"There are several potential explanations for our pattern of findings," the authors noted. "The most plausible and consistent explanation may be through associations with sleep disturbance. VMS overall are associated with objective and subjective sleep disturbance, 28 and individuals with disruptions in both the quantity and quality of sleep have a higher risk of diabetes."
Gray's group found sleep disturbances were commonly reported among the cohort, with 36% of women having experienced short sleep durations. Similarly, 24% of women were considered to be at high risk of sleep-disordered breathing, while 31% were at high risk of insomnia. Those who experienced more severe VMS, as well as experiencing both hot flashes and night sweats, were more likely to report sleep disturbances.
Study limitations included the fact that much of the cohort were clinical trial participants, which "were likely healthier than the general population," they stated.
While the results do not support different clinical care for women who experience VMS, "they suggest that leveraging the immediate repercussions of VMS may be a particularly effective strategy for eliciting behavior change among affected women as compared with counseling about the more distant and abstract future risk of diabetes and CVD," the authors said.
"Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease," noted JoAnn Pinkerton, MD, executive director of the North American Menopause Society, in a press release. "Suggestions include getting regular exercise and adequate sleep, avoiding excess alcohol, stopping smoking, and eating a heart-healthy diet. For symptomatic women, hormone therapy started near menopause improves menopause symptoms and reduces the risk of diabetes."
Click here for the American Association of Clinical Endocrinologists' comprehensive type 2 diabetes management algorithm and guidelines for the treatment of menopause.
The study was supported by the US Department of Veterans Affairs Health Services Research & Development Program.
Gray and co-authors disclosed no relevant relationships with industry.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
