Abstract TU280: Endometriosis subtypes and risk of type 2 diabetes: advancing research in cardiovascular health and endometriosis study (ARCHES) retrospective cohort study

Maggie Fuzak, Bin Yan, Karen Schliep, Leslie Farland, Michael Varner, Jenna Krall, Anna Pollack
In: Circulation · 2026 · vol. 153(Suppl_1) · doi:10.1161/cir.153.suppl_1.tu280 · W7160107564
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This retrospective cohort study found that women with endometriosis, particularly other site (OS) endometriosis, had a significantly increased risk of developing type 2 diabetes across all subtypes compared to women without the condition.

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This retrospective cohort study investigates the association between specific endometriosis subtypes and the subsequent risk of developing type 2 diabetes within the ARCHES framework. The research utilizes large-scale health data to analyze whether different classifications of endometriosis confer varying levels of metabolic risk compared to non-endometriosis controls. Key findings indicate that certain deep infiltrating endometriosis phenotypes are linked to a statistically significant increase in type 2 diabetes incidence, highlighting a potential shared inflammatory or hormonal pathway. This paper is centrally about endometriosis — specifically examining how distinct subtypes influence long-term cardiovascular and metabolic health outcomes.

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Abstract

Endometriosis is a chronic inflammatory condition that affects ~11% of reproductive-aged women and is characterized by growth of endometrial-like tissue outside the uterus. Chronic inflammation contributes to the development of type 2 diabetes (T2D) by impairing insulin sensitivity and glucose uptake. Despite overlapping inflammatory pathways, prior studies have reported inconsistent associations between endometriosis and T2D. We conducted a population-based retrospective cohort study using the Utah Population Database (UPDB), a statewide, multigenerational resource that links electronic health records, vital records, and administrative data. The cohort included women born in or after 1935 with documented Utah residency between 1996 and 2021 (N = 2,939,380). Endometriosis diagnoses (n = 99,978) were ascertained from International Classification of Diseases (ICD-9/10) codes and categorized as superficial peritoneal (SE), ovarian (OE), deep infiltrating (DE), adenomyosis, or other site (OS; including scar, bladder, umbilicus, and lung). T2D diagnoses were identified using ICD-9 codes 250.x0 and 250.x2 and ICD-10 codes E11. We fit Cox proportional hazards models with time-varying endometriosis exposure and calendar time as the time scale to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident T2D, adjusting for birth year, birth state, race/ethnicity, age, and body mass index (BMI) at cohort entry. Women with endometriosis had a 46% higher risk of developing T2D compared with women without endometriosis (aHR = 1.46; 95% CI: 1.43, 1.50). Elevated hazards were observed across all subtypes: SE (aHR = 1.67; 95% CI: 1.61, 1.74), OE (aHR = 1.61; 95% CI: 1.53, 1.68), and DE (aHR = 1.45; 95% CI: 1.24, 1.69). The strongest association was for OS endometriosis (aHR = 2.00; 95% CI: 1.90, 2.10); adenomyosis was also associated with increased risk (aHR = 1.34; 95% CI: 1.20, 1.38). These findings underscore the importance of understanding the metabolic consequences of chronic inflammatory conditions such as endometriosis.
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Abstract

TU280: Endometriosis subtypes and risk of type 2 diabetes: advancing research in cardiovascular health and endometriosis study (ARCHES) retrospective cohort study

Abstract

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