Diabetes Metab J.  2024 Nov;48(6):1105-1113. 10.4093/dmj.2023.0444.

Association of Uterine Leiomyoma with Type 2 Diabetes Mellitus in Young Women: A Population-Based Cohort Study

• Sung JH
• Kim KS
• Han K
• Park CY

• KMID: 2561794
• DOI: http://doi.org/10.4093/dmj.2023.0444

Abstract

Background
We investigated the association between uterine leiomyoma (UL) and incident type 2 diabetes mellitus (T2DM) in young women.
Methods
A nationwide population-based cohort study of 2,541,550 women aged between 20 and 40 years was performed using the National Health Information Database. Cox proportional hazards models were used to analyze the risk of incident T2DM according to the presence of UL and myomectomy.
Results
The mean age was 29.70 years, and mean body mass index was 21.31 kg/m2. Among 2,541,550 participants, 18,375 (0.72%) women had UL. During a median 7.45 years of follow-up, 23,829 women (0.94%) were diagnosed with T2DM. The incidence of T2DM in women with UL (1.805/1,000 person-years) was higher than in those without UL (1.289/1,000 person-years). Compared with women without UL, women with UL had a higher risk of incident T2DM (hazard ratio, 1.216; 95% confidence interval [CI], 1.071 to 1.382). Women with UL who did not undergo myomectomy had a 1.505 times (95% CI, 1.297 to 1.748) higher risk for incident T2DM than women without UL. However, women with UL who underwent myomectomy did not have increased risk for incident T2DM.
Conclusion
Young women with UL were associated with a high risk of incident T2DM. In addition, myomectomy seemed to attenuate the risk for incident T2DM in young women with UL.

Keyword

Cohort studies; Diabetes mellitus, type 2; Leiomyoma; Surgery; Young adult

Figure

• 

  Fig. 1. The cumulative incidence of type 2 diabetes mellitus. (A) Stratified according to presence of uterine leiomyoma adjusted for age, smoking status, alcohol consumption, regular exercise, hypertension, dyslipidemia, body mass index, and estimated glomerular filtration rate (P<0.001). (B) Stratified according to myomectomy adjusted for age, smoking status, alcohol consumption, regular exercise, hypertension, dyslipidemia, body mass index, and estimated glomerular filtration rate (P<0.001).

• 

Reference

1. Management of symptomatic uterine leiomyomas: ACOG practice bulletin, number 228. Obstet Gynecol. 2021; 137:e100–15.

2. Qin H, Lin Z, Vasquez E, Luan X, Guo F, Xu L. Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis. J Epidemiol Community Health. 2021; 75:197–204.

3. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020; 149:3–9.

4. Kim JJ, Kurita T, Bulun SE. Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer. Endocr Rev. 2013; 34:130–62.

5. Lee M, Chung YJ, Kim HK, Hwang H, Park JY, Shin I, et al. Estimated prevalence and incidence of uterine leiomyoma, and its treatment trend in South Korean women for 12 years: a national population-based study. J Womens Health (Larchmt). 2021; 30:1038–46.

6. Tak YJ, Lee SY, Park SK, Kim YJ, Lee JG, Jeong DW, et al. Association between uterine leiomyoma and metabolic syndrome in parous premenopausal women: a case-control study. Medicine (Baltimore). 2016; 95:e5325.

7. Ciavattini A, Delli Carpini G, Moriconi L, Clemente N, Orici F, Boschi AC, et al. The association between ultrasound-estimated visceral fat deposition and uterine fibroids: an observational study. Gynecol Endocrinol. 2017; 33:634–7.

8. Sun K, Xie Y, Zhao N, Li Z. A case-control study of the relationship between visceral fat and development of uterine fibroids. Exp Ther Med. 2019; 18:404–10.

9. Takeda T, Sakata M, Isobe A, Miyake A, Nishimoto F, Ota Y, et al. Relationship between metabolic syndrome and uterine leiomyomas: a case-control study. Gynecol Obstet Invest. 2008; 66:14–7.

10. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005; 365:1415–28.

11. Hebbar S, Chaya V, Rai L, Ramachandran A. Factors influencing endometrial thickness in postmenopausal women. Ann Med Health Sci Res. 2014; 4:608–14.

12. Januzzi JL Jr, Butler J, Sattar N, Xu J, Shaw W, Rosenthal N, et al. Insulin-like growth factor binding protein 7 predicts renal and cardiovascular outcomes in the canagliflozin cardiovascular assessment study. Diabetes Care. 2021; 44:210–6.

13. Yang Y, Yao S, Ding JM, Chen W, Guo Y. Enhancer-gene interaction analyses identified the epidermal growth factor receptor as a susceptibility gene for type 2 diabetes mellitus. Diabetes Metab J. 2021; 45:241–50.

14. Jeong IK, Byun JK, Noh J, Kim SW, Chung YS, Park TS, et al. Reference ranges of serum insulin-like growth factor-I and insulin-like growth factor binding protein-3: results from a multicenter study in healthy Korean adults. Endocrinol Metab (Seoul). 2020; 35:954–9.

15. Tseng CH. Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients. Ther Adv Endocrinol Metab. 2019; 10:2042018819895159.

16. Chiang CH, Chen W, Tsai IJ, Hsu CY, Wang JH, Lin SZ, et al. Diabetes mellitus risk after hysterectomy: a population-based retrospective cohort study. Medicine (Baltimore). 2021; 100:e24468.

17. Brandon DD, Bethea CL, Strawn EY, Novy MJ, Burry KA, Harrington MS, et al. Progesterone receptor messenger ribonucleic acid and protein are overexpressed in human uterine leiomyomas. Am J Obstet Gynecol. 1993; 169:78–85.

18. Padmanabhan S, Lee VW, Mclean M, Athayde N, Lanzarone V, Khoshnow Q, et al. The association of falling insulin requirements with maternal biomarkers and placental dysfunction: a prospective study of women with preexisting diabetes in pregnancy. Diabetes Care. 2017; 40:1323–30.

19. Ryan AS, Nicklas BJ, Berman DM. Hormone replacement therapy, insulin sensitivity, and abdominal obesity in postmenopausal women. Diabetes Care. 2002; 25:127–33.

20. Picard F, Wanatabe M, Schoonjans K, Lydon J, O’Malley BW, Auwerx J. Progesterone receptor knockout mice have an improved glucose homeostasis secondary to beta-cell proliferation. Proc Natl Acad Sci U S A. 2002; 99:15644–8.

21. Moon JH, Jang Y, Oh TJ, Jung SY. The risk of type 2 diabetes mellitus according to changes in obesity status in late middle-aged adults: a nationwide cohort study of Korea. Diabetes Metab J. 2023; 47:514–22.

22. Kim KS, Park SW, Cho YW, Kim SK. Higher prevalence and progression rate of chronic kidney disease in elderly patients with type 2 diabetes mellitus. Diabetes Metab J. 2018; 42:224–32.

23. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes-2024. Diabetes Care. 2024; 47(Suppl 1):S219–30.

24. Ko SH, Han KD, Park YM, Yun JS, Kim K, Bae JH, et al. Diabetes mellitus in the elderly adults in Korea: based on data from the Korea National Health and Nutrition Examination Survey 2019 to 2020. Diabetes Metab J. 2023; 47:643–52.

25. American Diabetes Association Professional Practice Committee. 13. Older adults: standards of care in diabetes-2024. Diabetes Care. 2024; 47(Suppl 1):S244–57.

26. Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, et al. 2023 Clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J. 2023; 47:575–94.

27. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2024. Diabetes Care. 2024; 47(Suppl 1):S158–78.