Trends in type 2 diabetes, prediabetes, and hyperglycemic recognition among menopausal women: A 20-year analysis of sociodemographic disparities

Background: Menopausal hormonal and metabolic changes may increase susceptibility to type 2 diabetes (T2D), yet long-term national trends and socio-demographic disparities in both T2D burden and hyperglycemia recognition among menopausal women remain insufficiently characterized. Objectives: To examine 20-year trends in T2D, prediabetes, and recognition of prediabetes- or diabetes-range hyperglycemia among U.S. menopausal women and to assess sociodemographic disparities associated with abnormal glycemic status. Design: Repeated cross-sectional analysis of continuous National Health and Nutrition Examination Survey (NHANES) cycles (2003-2023). Methods: The analytic sample included 3,574 naturally menopausal women aged ≥45 years with fasting plasma glucose, HbA1c, and diabetes questionnaire data. T2D and prediabetes were defined using ADA-aligned biomarker thresholds. Hyperglycemia was operationalized specifically as biomarker-defined prediabetes- or diabetes-range hyperglycemia (fasting plasma glucose ≥100 mg/dL or HbA1c ≥5.7%). Recognition status was categorized as recognized hyperglycemia, unrecognized hyperglycemia, or normoglycemia based on glycemic biomarkers and self-reported prior clinician communication of diabetes or borderline diabetes. Survey-weighted prevalence estimates, trend models across cycles, and multinomial/survey logistic regression assessed associations with race/ethnicity, education, marital status, employment, and poverty-to-income ratio (PIR). Results: Overall crude prevalence was 13.7% for diabetes and 34.8% for prediabetes. From 2003 to 2023, diabetes rose modestly from 11.3% to 11.9% (p<.001), while prediabetes increased substantially from 24.3% to 35.2% (p<.001). Unrecognized hyperglycemia increased from 23.9% to 32.9% (p<.001). Higher odds of diabetes were observed for non-Hispanic Black (OR=4.03) and Hispanic/Latina women (OR=2.81) versus non-Hispanic White women, for ≤high school education (OR=2.77) versus ≥4-year degree, for disability (OR=1.46) and retirement (OR=1.50) versus employment, and for PIR<1.3 (OR=1.54) versus PIR>3.5; marital status was not associated. Similar patterns were observed for recognized and unrecognized hyperglycemia. Conclusion: Among menopausal women, prediabetes and unrecognized hyperglycemia increased over two decades, with pronounced disparities by race/ethnicity and socioeconomic position. Integrating routine glycemic screening and tailored, culturally responsive prevention efforts into menopausal care may reduce unrecognized abnormal glycemic status and related inequities.