Vasomotor symptom characteristics: are they risk factors for incident diabetes?

Abstract

Objective: Vasomotor symptoms (VMS), encompassing hot flashes and night sweats, may be associated with diabetes, but evidence is limited. We sought to estimate these associations.

Methods: Among 150,007 postmenopausal Women's Health Initiative participants from 1993 to 2014, we prospectively examined associations of incident diabetes with VMS characteristics at enrollment: any VMS, severity (mild/ moderate/severe), type (hot flashes/night sweats), timing (early [premenopausal or perimenopausal]/late [postmenopausal]), and duration. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Mean duration of follow-up was 13.1 years. VMS prevalence was 33%. Reporting any VMS was associated with 18% increased diabetes risk (95% CI 1.14, 1.22), which increased with severity (mild: HR 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) and duration (4% per 5 years, 95% CI 1.03, 1.05), independent of obesity. Diabetes risk was more pronounced for women reporting any night sweats (night sweats only: HR 1.20, 95% CI 1.13, 1.26; night sweats and hot flashes: HR 1.22, 95% CI 1.17, 1.27) than only hot flashes (HR 1.08, 95% CI 1.02, 1.15) and was restricted to late VMS (late: HR 1.12, 95% CI 1.07, 1.18; early and late: HR 1.16, 95% CI 1.11, 1.22; early: HR 0.99, 95% CI 0.95, 1.04).

Conclusions: VMS are associated with elevated diabetes risk, particularly for women reporting night sweats and postmenopausal symptoms. The menopause transition may be an optimal window for clinicians to discuss long-term cardiovascular/metabolic risk with patients and leverage the bother of existing symptoms for behavior change to improve VMS and reduce diabetes risk.

Trial registration: ClinicalTrials.gov NCT00000611.

Conflict of interest statement

Financial disclosure/conflicts of interest: The authors have no conflicts of interest to report.

Figures

Figure 1

Flow diagram for study inclusion and exclusion. Participants with prevalent diabetes at baseline, without data on vasomotor symptoms (VMS), or lacking follow-up data on diabetes were excluded from main analyses.

Figure 2

Associations of hot flash and night sweat severity with incident diabetes. Panel (A) shows the relationship between hot flash severity and diabetes across severity of night sweats. Point estimates reflect the hazard ratio for diabetes comparing women with mild hot flashes to no hot flashes (black circles) and moderate/severe hot flashes to no hot flashes (white circles). Increasing severity of hot flashes was associated with slightly higher risk of diabetes among women with no night sweats; there were no associations among women with mild or moderate/severe night sweats. Panel (B) displays the relationship between night sweat severity and diabetes across severity of hot flashes. Point estimates reflect the hazard ratio for diabetes comparing women with mild night sweats to no night sweats (black squares) and moderate/severe night sweats to no night sweats (white squares). Across all hot flash severities, increasing severity of night sweats was positively associated with diabetes risk. There was no evidence of a multiplicative effect of hot flashes and night sweats (p-value for interaction=0.12).

Figure 3

Unadjusted prevalence of sleep disturbance by vasomotor symptom (VMS) characteristics. Women with any VMS had a greater prevalence of each sleep disturbance than women without VMS, and prevalence increased with symptom severity. Insomnia and sleep disordered breathing were more common among women with any night sweats than among those with only hot flashes. Compared to women with only early (pre- or perimenopausal) VMS, women with any late (postmenopausal) symptoms had a greater prevalence of sleep disturbance.