Hot flashes—especially those accompanied by night sweats—could be not only a routine symptom of menopause but also a precursor to diabetes, according to a study published this week in Menopause, the journal of the North American Menopause Society (NAMS).

While hot flashes are run of the mill, they have been linked to increased risks for a handful of health problems, including heart disease, NAMS reported in a release. Now, results from analysis of the Women’s Health Initiative (WHI) are suggesting they can increase a woman’s risk of developing diabetes by almost 20 percent.

Researchers extracted the data of more than 150,000 postmenopausal women from the WHI database and found that 33 percent had experienced hot flashes during menopause. Any incidence of hot flashes, they found, was associated with an 18 percent increase in diabetes risk—a risk increased as duration and severity of hot flashes persisted.

Elevated diabetes risk was clearest in women who reported any type of night sweats during menopause, the researchers found, but only if those women experienced hot flashes late in their menopause transition.

“This study showed that, after adjustment for obesity and race, women with more severe night sweats, with or without hot flashes, still had a higher risk of diabetes,” NAMS Executive Director JoAnn Pinkerton said in the release. “Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease. Suggestions include getting regular exercise and adequate sleep, avoiding excess alcohol, stopping smoking and eating a heart-healthy diet. For symptomatic women, hormone therapy started near menopause improves menopause symptoms and reduces the risk of diabetes.”