Secondary Logo

Institutional members access full text with Ovid®

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

Gray, Kristen, E., PhD1,2; Katon, Jodie, G., PhD1,2; LeBlanc, Erin, S., MD, MPH3; Woods, Nancy, F., PhD, RN4; Bastian, Lori, A., MD, MPH5,6; Reiber, Gayle, E., PhD1,2,7; Weitlauf, Julie, C., PhD8,9; Nelson, Karin, M., MD, MSHS1,10,11; LaCroix, Andrea, Z., PhD12

doi: 10.1097/GME.0000000000001033
Original Articles

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.

1Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA

2Department of Health Services, University of Washington School of Public Health, Seattle, WA

3Kaiser Permanente Center for Health Research, Portland, OR

4Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA

5Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT

6Department of Internal Medicine, Yale School of Medicine, New Haven, CT

7Department of Epidemiology, University of Washington School of Public Health, Seattle, WA

8Mental Illness, Research, Education and Clinical Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA

9Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA

10VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, WA

11Department of Medicine, University of Washington School of Medicine, Seattle, WA

12Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA.

Address correspondence to: Kristen E. Gray, PhD, 1660 S. Columbian Way, S-152, Seattle, WA 98108. E-mail:

Received 2 March, 2017

Revised 23 October, 2017

Accepted 23 October, 2017

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs.

This work was presented in poster format at the American Diabetes Association 76th Scientific Sessions, June 10-14, 2016, New Orleans, LA.

Funding/support: The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004. This work was supported by the US Department of Veterans Affairs Health Services Research & Development Program (Postdoctoral Fellowship TPP #61-029 to K.G., Career Development Award CDA #13-266 to J.K., and Research Career Scientist Award RCS #98-353 to G.R.).

Financial disclosure/conflicts of interest: None reported.

Clinical trials registration: NCT00000611l (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2018 by The North American Menopause Society.