Could hot flushes be precursor to diabetes?

Analysis of Women's Health Initiative data demonstrates effect of severity and duration of hot flushes on risk of developing diabetes

Hot flushes, undoubtedly the most common symptom of menopause, are not just uncomfortable and inconvenient, but numerous studies demonstrate they may increase the risk of serious health problems, including heart disease. This study suggests that hot flushes (especially when accompanied by night sweats) also may increase the risk of developing diabetes. 

As reported in "Vasomotor symptom characteristics: are they risk factors for incident diabetes?" data was analyzed from the more than 150,000 postmenopausal women who participated in the Women's Health Initiative (WHI) to confirm that the occurrence of hot flushes was associated with an elevated diabetes risk. Of the total population studied, 33% of the women had experienced hot flushes. Any incidence of hot flushes was associated with an 18% increased diabetes risk, and this risk continued to climb on the basis of the severity and duration of the hot flushes. Moreover, diabetes risk was the most pronounced for women reporting any type of night sweats but only if the onset of hot flushes occurred late in the menopause transition.

Diabetes is a serious health risk currently affecting 15% of women aged 55 years and older. Its incidence is expected to more than double by 2050. Compared with men with diabetes, women with diabetes have a higher risk of being hospitalized for or dying from diabetes and its complications, which makes the timely identification and management of diabetes through lifestyle intervention or medical management critical.

"This study showed that, after adjustment for obesity and race, women with more severe night sweats, with or without hot flushes, still had a higher risk of diabetes," says Dr JoAnn Pinkerton, NAMS executive director. "Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease. 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."

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.

Reference

Kristen E. Gray, Jodie G. Katon, Erin S. LeBlanc, Nancy F. Woods, Lori A. Bastian, Gayle E. Reiber, Julie C. Weitlauf, Karin M. Nelson, Andrea Z. LaCroix. Vasomotor symptom characteristics. Menopause, 2017; 1 DOI: 10.1097/GME.0000000000001033

Content updated 6 December 2017