Farland, L. V., Degnan, W. J., Harris, H. R., Tobias, D. K., & Missmer, S. A. (2021). A prospective study of endometriosis and risk of type 2 diabetes. Diabetologia. https://doi.org/10.1007/s00125-020-05347-6
Farland LV, Degnan WJ, Harris HR, Tobias DK, Missmer SA. A prospective study of endometriosis and risk of type 2 diabetes. Diabetologia. 2021. doi:10.1007/s00125-020-05347-6
Farland, Leslie V., et al. "A prospective study of endometriosis and risk of type 2 diabetes." Diabetologia, 2021.
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Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Department of Obstetrics and Gynecology, College of Medicine -...03m2x1q45
Endometriosis Isn't Linked to Diabetes Risk, Except in Some Women
This study tracked more than 112,000 nurses for over 25 years. Endometriosis was not linked to a higher overall risk of type 2 diabetes. In three groups, endometriosis was linked to a small rise in risk: women who were not obese, women with no infertility history, and women with no gestational diabetes history.
Key Findings
The study included 112,037 nurses. The study confirmed 8,496 new cases of type 2 diabetes over 2,691,401 person-years of tracking.
Endometriosis diagnosed by laparoscopy was not linked to higher diabetes risk once other health factors were weighed in (hazard ratio 1.06, 95% confidence interval 0.98 to 1.13).
A separate model that also adjusted for factors that might sit on the causal path found no higher risk either (hazard ratio 0.94, 95% confidence interval 0.87 to 1.00).
Non-obese women with endometriosis had slightly more diabetes risk (hazard ratio 1.17, 95% CI 1.02 to 1.35); obese women showed no added risk (hazard ratio 1.00, 95% CI 0.91 to 1.09).
The same small rise appeared with no infertility history (HR 1.14, 95% CI 1.04 to 1.25) and, in mothers, no gestational diabetes history (HR 1.11, 95% CI 1.01 to 1.22).
Interpretation
This is an observational cohort study of nurses, the first to look prospectively at the link between endometriosis and type 2 diabetes risk. The study's size, more than 112,000 women, and long follow-up, over 25 years, make it a strong dataset. Diabetes cases had to meet strict diagnostic criteria, and self-reported endometriosis was checked against medical records in a sample of participants. Still, a cohort study like this can show a link. The study cannot prove that endometriosis causes diabetes. All the women were nurses with close ties to the medical system, so results may not apply elsewhere. Patterns seen in smaller groups need to be confirmed in future studies.
RRM Context
Endometriosis is often seen only as a pain or fertility problem. This paper adds to other findings in the same group of nurses. Earlier work found a 60% higher rate of heart disease linked to endometriosis. Restorative reproductive medicine treats endometriosis as a disease of the whole body.
Our editorial summary of this paper, not the article's abstract.
Abstract
AIMS/HYPOTHESIS: The objective of this study was to investigate the association between laparoscopically confirmed endometriosis and risk of type 2 diabetes.
Methods
We used data from the Nurses' Health Study II, a prospective cohort of female nurses followed for >25 years (N = 112,037). We used Cox proportional hazards models to estimate the HRs and 95% CIs of incident, confirmed type 2 diabetes (n = 8496 participants) adjusted a priori for confounding factors. We additionally investigated differences in the relationship between endometriosis and type 2 diabetes by age (<50 or ≥50 years), BMI (<30 or ≥30 kg/m2), infertility history, menopausal status and history of gestational diabetes mellitus (GDM; restricted to parous women).
Results
We saw no association between laparoscopically confirmed endometriosis and risk of type 2 diabetes in multivariable confounder-adjusted models (HR 1.06 [95% CI 0.98, 1.13]) or models accounting for potential mediating factors (HR 0.94 [95% CI 0.87, 1.00]). However, we observed modest differences in the association between endometriosis and type 2 diabetes by BMI group, history of infertility and history of GDM. Among non-obese women (HR 1.17 [95% CI 1.02, 1.35]), women who never experienced infertility (HR 1.14 [95% CI 1.04, 1.25]) and women who never experienced GDM (HR 1.11 [95% CI 1.01, 1.22]), endometriosis was associated with greater risk of type 2 diabetes.
CONCLUSIONS/INTERPRETATION: Overall, women with endometriosis were not at increased risk of type 2 diabetes. However, among subgroups at low risk for type 2 diabetes (i.e. non-obese women and women with no prior history of infertility or GDM), endometriosis was associated with a modest increased risk of type 2 diabetes.
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