Timing and type of menopause are not risk factors for the onset of diabetes: a UK Biobank cohort study

OBJECTIVES: Early and premature menopause are positively associated with coronary heart disease and stroke, but there is less evidence regarding its relationship with the onset of diabetes. The primary objective of this study is to assess the association between the timing and type of menopause and the possible development of type 1 or 2 diabetes. METHODS: Participants from the UK Biobank were enrolled between 2006 and 2010, with follow-up to the end of 2023. The outcome variable was diagnosis of type 1 or 2 diabetes during follow-up, and the main explanatory variable was age at menopause (normal above 45 y, early 40-45 y, and premature below 40 y). Behavioral factors, comorbidities, and blood tests were also collected. Survival models with Weibull distribution were fitted to the time of diabetes onset. RESULTS: Of the 146,764 women analyzed over a mean follow-up of 14.5 years, 6,598 women developed diabetes (cumulative incidence 4.5%). Rates were higher in women with earlier menopause (4.2% at age above 45 y, 5.2% at ages 40-45 y, and 7.4% before age 40); however, the multivariate analysis showed no independent association (40-45 y: hazard ratio: 1.00; <40 y, hazard ratio: 0.97), taking the normal age of menopause as the reference. Surgical menopause was likewise not associated with a greater risk of diabetes compared with natural menopause. CONCLUSIONS: In a large cohort of women with long-term follow-up, no independent or clinically significant relationship between age or type of menopause and the onset of diabetes was observed.