Diabetes and uterine fibroid diagnosis in midlife: Study of Women's Health Across the Nation (SWAN).

Autor:	Mitro SD; Division of Research, Kaiser Permanente Northern California, Pleasanton, CA., Waetjen LE; Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Davis, CA., Lee C; Division of Research, Kaiser Permanente Northern California, Pleasanton, CA., Wise LA; Department of Epidemiology, Boston University School of Public Health, Boston, MA., Zaritsky E; Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA., Harlow SD; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI., El Khoudary SR; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA., Santoro N; Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO., Solomon DH; Brigham and Women's Hospital, Boston, MA., Thurston RC; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA., Hedderson MM; Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.; Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Sep 11. Date of Electronic Publication: 2024 Sep 11.
DOI:	10.1210/clinem/dgae625
Abstrakt:	Background: Fibroids are non-cancerous uterine tumors potentially associated with cardiovascular risk factors. We examined prospectively associations of glucose, insulin, sex hormone binding globulin (SHBG), and diabetes with incidence of fibroid diagnoses in midlife. Methods: Participants in the Study of Women's Health Across the Nation (SWAN) cohort (n=2570) reported fibroid diagnoses at enrollment (1996-1997) and 13 follow-up visits (1996-2013). At all visits, we measured glucose, insulin, and SHBG in fasting blood samples and calculated homeostatic model assessment for insulin resistance (HOMA-IR). Diabetes was defined using glucose levels, self-reported diabetes, or diabetes medication use. We used discrete-time survival models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations of time-varying biomarkers and diabetes with incident fibroid diagnoses, adjusted for demographics and healthcare utilization. We also evaluated effect modification by menopausal status. Results: At baseline, 2.7% of participants (n=70) were using diabetes medication. Time-varying glucose, insulin, HOMA-IR, and SHBG were not associated with fibroid diagnosis. However, diabetes was associated with a 28% lower incidence of fibroid diagnosis (adjusted HR: 0.72, 95% CI: 0.44, 1.17), driven by participants using metformin (adjusted HR: 0.49, 95% CI: 0.21, 1.12), though precision was limited. After stratification by menopausal status, higher HOMA-IR and insulin were associated with greater incidence of fibroid diagnosis during premenopause but not perimenopause, while the inverse association between diabetes and fibroids was strongest during perimenopause. Conclusion: The effect of diabetes and biomarkers on fibroids may vary by menopausal status. Fibroid risk may increase with insulin resistance and decrease with diabetes treatment. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)
Databáze:	MEDLINE
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