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Prior studies have reported largely null associations with type 2 diabetes, potentially missing subtype-specific and subgroup heterogeneity. We investigated the association between endometriosis, including clinically relevant subtypes, and incident type 2 diabetes, and assessed effect modification by menopausal status, BMI and history of gestational diabetes mellitus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assembled a dynamic population-based cohort of 2,939,364 individuals assigned as female at birth from the Utah Population Database (1996\u20132021). Endometriosis and subtypes were identified using validated ICD-9\/10 codes and modelled as time-varying exposures. Incident type 2 diabetes was ascertained using ICD codes. Cox proportional hazards models with calendar time as the time scale were used to estimate HRs and 95% CIs, adjusting for birth year, birth state, race\/ethnicity, age and BMI at cohort entry. Stratified analyses evaluated effect modification by menopausal status, BMI and history of gestational diabetes mellitus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a mean follow-up duration of 10.8 years, 99,978 women were diagnosed with endometriosis. Endometriosis was associated with a 46% higher risk of type 2 diabetes compared with no endometriosis (aHR 1.46; 95% CI 1.43, 1.50). Risk varied by subtype, with the strongest associations observed for \u2018other site\u2019 endometriosis (specified site: aHR 2.67; 95% CI 2.51, 2.84; unspecified site: aHR 2.47; 95% CI 2.35, 2.60). Associations were stronger among premenopausal women than postmenopausal women (aHR 1.55; 95% CI 1.50, 1.60) and those with BMI &lt;30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      than those in higher BMI categories (aHR 2.39; 95% CI 2.34, 2.44), and were present regardless of history of gestational diabetes mellitus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Endometriosis was associated with increased type 2 diabetes risk, with substantial heterogeneity by subtype and metabolic context. Associations were strongest among individuals who are traditionally considered at lower baseline risk, although these findings should be interpreted cautiously given the potential for residual confounding and detection bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06828-w","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:30:32Z","timestamp":1786023032000},"page":"3570-3579","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endometriosis subtypes and risk of type 2 diabetes: the Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES) retrospective cohort study"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6098-0559","authenticated-orcid":false,"given":"Maggie","family":"Fuzak Nunziato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen C.","family":"Schliep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie V.","family":"Farland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Varner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna R.","family":"Krall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Rexrode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hediyeh","family":"Baradaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Majersik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Page","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Z.","family":"Pollack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"issue":"2","key":"6828_CR1","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.fertnstert.2011.05.087","volume":"96","author":"GM Buck Louis","year":"2011","unstructured":"Buck Louis GM, Hediger ML, Peterson CM et al (2011) Incidence of endometriosis by study population and diagnostic method: the ENDO study. 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We also thank the University of Utah Clinical and Translational Science Institute (CTSI) (funded by NIH Clinical and Translational Science Awards), UPDB staff, University of Utah Information Technology Services and Biomedical Informatics Core for establishing the Master Subject Index between the UPDB, the University of Utah Health Sciences Center and Intermountain Health. Some of the data were presented as a poster presentation at the AHA EPI Lifestyle Conference, Boston, Massachusetts, USA, 17\u201320 March 2026.","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study used data from the Utah Population Database (UPDB). The data are subject to strict privacy and regulatory protections and cannot be made publicly available. Qualified researchers may request access through the UPDB Resource for Genetic and Epidemiologic Research (RGE), subject to review and approval by the University of Utah Institutional Review Board and applicable data use agreements.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL164715. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The research was supported by the National Center for Research Resources (NCRR) grant \u2018Sharing Statewide Health Data for Genetic Research\u2019 (R01 RR021746, G. Mineau, principal investigator), with additional support from the Utah Department of Health and the University of Utah. We also acknowledge partial support for the UPDB through grant P30 CA2014 from the National Cancer Institute, and from the University of Utah, the University of Utah\u2019s Program in Personalized Health, and the Utah Clinical and Translational Science Institute.","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"MKFN contributed to the conception and design of the study, data acquisition, data analysis and interpretation of the results, and drafted the manuscript. BY contributed to data acquisition, data analysis and interpretation of the results, and critically revised the manuscript. KCS, LVF, AZP, JP, MWV, JRK, KR, HB and BB contributed to the conception and design of the study and interpretation of the results, and critically revised the manuscript for important intellectual content. JM contributed to the conception and design of the study and interpretation of the results, supervised the study, and critically revised the manuscript. All authors approved the final version of the manuscript. MKFN is responsible for the integrity of the work as a whole.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}