Menopause status may influence mortality patterns in women with young-onset type 2 diabetes mellitus (T2DM). A cohort study published in Frontiers in Endocrinology found that postmenopausal women with young-onset disease had higher mortality than premenopausal women with later-onset diabetes.

The study included 5,984 women with T2DM enrolled through the National Basic Public Health Service Management Program in Huai’an City, China, between December 2013 and January 2014. Mortality data were matched with the Huai’an Resident Mortality Database through December 31, 2024. Among participants, 387 had young-onset diabetes (YOD), and 5,597 had late-onset diabetes (LOD). Mean age was 61.77 years.

Participants were grouped as young menopausal (YM), young premenopausal (YP), non-young menopausal (NYM), and non-young premenopausal (NYP). During 10 years of follow-up, 1,293 deaths occurred, yielding an all-cause mortality rate of 21.6%. Overall mortality remained lower in YOD than in LOD.

Subgroup analysis showed the highest mortality rate in the NYM group at 24%, followed by the YM group at 15%, while the YP group had the lowest mortality rate at 3.7%. Survival curve analysis showed the YM group had the least favorable survival among young-onset groups, whereas the YP group had the most favorable survival.

Multivariable Cox regression found that triglyceride-glucose-body mass index (TyG-BMI) was independently associated with lower mortality risk in the YM group (hazard ratio [HR], 0.980; 95% confidence interval [CI], 0.965-0.997; P=0.018). Each 1 standard deviation increase in TyG-BMI was associated with a 2% lower mortality risk. Uric acid was a common mortality risk factor across the onset-age and menopause groups.

The findings suggest that earlier identification of lower TyG-BMI levels in postmenopausal women with YOD may help recognize higher-risk individuals and support earlier risk-directed intervention.