Identification of risk factors for type 2 diabetes across age-based proxies of early and late postmenopausal stages in prediabetic women.

BACKGROUND

Prediabetes is increasingly prevalent, and women transitioning through menopause may face a particularly elevated risk of progressing to type 2 diabetes (T2DM). Estrogen deficiency promotes adiposity, insulin resistance, and inflammation, potentially amplifying the metabolic burden of aging. However, the determinants of T2DM in these women remain insufficiently characterized.

METHODS

This retrospective study included 229 prediabetic women evaluated at a tertiary-care hospital and followed for up to 5.5 years. Prediabetes was defined according to ADA criteria and women were classified as premenopausal (< 51 years), early postmenopausal (51-60 years), or late postmenopausal (> 60 years). Clinical and biochemical variables were analyzed for hazard ratios (HR) of T2DM using Cox regression, and Kaplan-Meier curves.

RESULTS

During follow-up, 18% of premenopausal and 35% of postmenopausal women developed T2DM. Higher BMI predicted T2DM in both groups. In postmenopausal women, IGT (HR: 2.59), hypertension (HR: 3.91), lower HDL-C (HR: 0.96), lower vitamin D (HR: 0.93), and reduced eGFR (HR: 0.97) were independently associated with T2DM. Stratification revealed that early post-menopause carried the highest incidence of T2DM. In early post-menopause, higher BMI and uric acid, and lower vitamin D were independent predictors, whereas in late post-menopause, hypertension and reduced eGFR were the strongest determinants.

CONCLUSIONS

Risk Factors associated with progression to T2DM in prediabetic women appear to differ across age-defined menopausal stages. Excess adiposity remains a key factor, whereas early post-menopause is characterized by additional associations with hyperuricemia and vitamin D deficiency. In late post-menopause, hypertension and declining renal function appear to be more prominent. These findings support stage-specific risk assessment and tailored preventive strategies in prediabetic women.