Women who have postmenopausal vasomotor symptoms (VMS), especially night sweats, have a higher risk for type 2 diabetes, according to a study published December 6 in Menopause. Further, the excess risk increased with the severity and duration of women’s symptoms, the researchers found.
“The most plausible and consistent explanation may be through associations with sleep disturbance,” write Kristen E. Gray, PhD, from the Veterans Affairs Puget Sound Health Care System and the University of Washington School of Public Health in Seattle, and colleagues. “VMS overall are associated with objective and subjective sleep disturbance, and individuals with disruptions in both the quantity and quality of sleep have a higher risk of diabetes.”
Sleep, then, may mediate associations between VMS and diabetes, they add.
“In particular, night sweats are more strongly associated with sleep disturbance than hot flashes, as they occur during the night, which may explain their more pronounced relationship with diabetes,” the authors write. “Our results also suggest that night sweats or their effects may be largely responsible for the association between VMS overall and diabetes.”
The researchers prospectively tracked and analyzed data for 150,007 postmenopausal women participating in the Women’s Health Initiative study to explore possible associations between incident diabetes and VMS from 1993 to 2014. In addition to looking at the severity of hot flashes and night sweats, the researchers looked at the timing of symptoms and how long they lasted.
Over an average 13 years of follow-up, 33% of participants experienced VMS, and 18,316 women developed diabetes.
Among the entire population, diabetes incidence was 9.3 per 1000 people per year of follow-up. When analyzed by subgroup, the incidence varied from 8.4 per 1000 person-years among women with no VMS at baseline to 11.3 per 1000 in women who had symptoms at baseline.
Women who reported any postmenopausal VMS had an 18% increased risk for diabetes (hazard ratio, 1.18; 95% confidence interval, 1.14 – 1.22) compared with those who reported no symptoms. Women with late postmenopausal VMS had a 12% increased risk, but the researchers found no statistically significant increased risk among women who exclusively had symptoms early, when premenopausal or perimenopausal. However, women who had both early and late symptoms had the largest increase in risk, at 16%.
Severity of VMS also moderated the risk associated with diabetes: Risk among women with severe symptoms was 48% higher than among women with no symptoms. Meanwhile, women with mild VMS had only a 13% risk for diabetes, and moderate symptoms were associated with a 29% increased diabetes risk.
Similarly, duration of symptoms and types of symptoms affected risk levels. Diabetes risk increased 4% for every 5 years that women experienced symptoms, separate from any risks associated with obesity. Night sweats were linked to a 20% increased risk for diabetes, whereas hot flashes alone were linked to an 8% increased risk. Having both night sweats and hot flashes was associated with a 22% increased risk for diabetes.
The authors urge caution in interpreting the results because they lack details on understanding the association. “[T]he directionality and nature of the association between sleep and night sweats is not clear,” the authors write. “It may be that women who are awake due to sleep disruptions are more likely to notice and report night sweats, conversely symptoms may trigger awakenings.”
The possibility that sleep disturbance mediates the link between VMS and diabetes is further supported by the pattern of sleep disturbances in the study population, according to Dr Gray and colleagues.
“When we examined the prevalence of sleep-disordered breathing, insomnia and short sleep duration by VMS characteristics, patterns mirrored the associations with diabetes,” the authors write. “In particular, women reporting night sweats (with or without concomitant hot flashes) had a higher prevalence of sleep-disordered breathing and insomnia, and women reporting late VMS had a higher prevalence of all sleep disturbances compared with the similar prevalence among women without any VMS, reporting only hot flashes, and only early symptoms.”
The authors note that relatively few studies have previously looked at the link between VMS and diabetes and thus far the results have been mixed. However, a Dutch group reported earlier this year that early menopause is linked to an increased risk for type 2 diabetes.
The research was funded by the National Institutes of Health, US Department of Health and Human Services, and US Department of Veterans Affairs Health Services Research & Development Program. The authors have disclosed no relevant financial relationships.
Menopause. Published online December 6, 2017. Abstract
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