Vulvovaginal candidiasis and type 2 diabetes: A nationwide retrospective cohort study

Aims: To examine whether vulvovaginal candidiasis (VVC) precedes type 2 diabetes and to quantify the possible time period between VVC and subsequent diabetes. Material and Methods: We conducted a nationwide retrospective primary healthcare study including 1 838 929 women aged 35–65 years in Sweden (2007–2018). Cox regression models were used to examine associations between VVC and type 2 diabetes, while controlling for possible confounders. Propensity-score-weighted analysis was also conducted. Results: The incidence rate of diabetes per 1000 person-years was 3.06 (95% confidence interval [CI] 3.05–3.08) in women without preceding VVC and 4.05 (95% CI 3.86–4.24) in women with preceding VVC. The incidence rate was particularly high in women aged 55 years and older with VVC: 9.56 (95% CI 8.01–11.11). Women with VVC had a hazard ratio (HR) of 1.41 (95% CI 1.28–1.55) for diabetes compared to women without VVC in the multivariable-adjusted model. The corresponding HR was 1.63 (95% CI 1.53–1.74) in propensity-score-weighted analysis. Women with prior VVC also seemed to have a stronger risk of diabetes with older age, particularly after the age of 55 years. The mean (range) time between VVC and subsequent diabetes was 0.57 (0–2) years, depending on the age of the woman. Conclusion: We found temporal associations between VVC and diabetes. The findings demonstrate that the presence of VVC may indicate a future diagnosis of diabetes, especially in women aged 55 years and older. This knowledge could be valuable for clinicians when treating women with VVC.