Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: Results from the MIND.IT Study Group of the Italian Society of Diabetology

doi:10.1016/j.numecd.2011.12.003

Nutrition, Metabolism and Cardiovascular Diseases

Volume 23, Issue 3, March 2013, Pages 235-241

https://doi.org/10.1016/j.numecd.2011.12.003 Get rights and content

Abstract

Background and aims

The study explores the degree of control of hyperglycaemia and cardiovascular (CV) disease risk factors in men and women with type 2 diabetes and the impact thereon of obesity, central adiposity, age and use of medications.

Methods and results

A cross-sectional survey was conducted at 10 hospital-based outpatients diabetes clinics. 1297 men and 1168 women with no previous CV events were studied. Women were slightly (only one year) older and more obese than men: average BMI was respectively 30.7 ± 5.7 vs 28.6 ± 4.1 kg/m² (p < 0.001), and prevalence of abdominal obesity was 86% vs 44% (p < 0.001). Women smoked less, but had higher HbA1c, LDL cholesterol, non-HDL cholesterol, systolic blood pressure and serum fibrinogen than men. Accordingly optimal targets for HbA1c (<7%), LDL cholesterol (<100 mg/dL), HDL cholesterol (>40 for men, >50 for women, mg/dL), and systolic blood pressure (<130 mmHg) were less frequently achieved by women than men (respectively 33.8% vs 40.2%; 14.6% vs 19.2%; 34.1% vs 44.5%; 68.8% vs 72%; p < 0.05 for all). Findings were confirmed after stratification for waist circumference (< or ≥ 88 cm for women; < or ≥ 102 cm for men), BMI (< or ≥ 25 kg/m²) or age (< or ≥ 65 years). As for treatment, women were more likely than men to take insulin, alone or in combination with oral hypoglycaemic drugs, to be under anti-hypertensive treatment, whereas the use of lipid lowering drugs was similar in men and women.

Conclusions

Control of hyperglycaemia and major CVD risk factors is less satisfactory in women than men. The gender disparities are not fully explained by the higher prevalence of total and central obesity in women; or by a less intensive medical management in women.

Section snippets

Methods

MIND.IT is a two-phase study which includes an observational survey and a cardiovascular primary prevention trial in type 2 diabetic patients. The observational survey was performed in 2004–2006 in 10 large diabetes clinics nationwide. The participating centres were invited to consecutively enrol about 250 eligible individuals. The main eligibility criteria were: diagnosis of type 2 diabetes for at least two years; age 50–70 years; no prior CV events; serum creatinine <1.5 mg/dL; no liver

Statistical analyses

The variables distribution was evaluated by the Kolmogorov–Smirnov test. Normally distributed variables are expressed as mean and standard deviation (SD), while not normally distributed variables as median and inter-quartile range.

Differences were tested by Chi-square for proportions, and by unpaired Students t-test or Wilcoxon test, as appropriate, for continuous variables. Analyses were conducted in the population as a whole and also after stratification for abdominal obesity, based on waist

Results

All together 1297 men and 1168 women were studied. On average women were slightly, but significantly older than men (61 ± 5 vs 60 ± 5 years, p = 0.007), had a substantially higher BMI (30.7 ± 5.7 vs 28.6 ± 4.1 kg/m², p < 0.001), and a much higher prevalence of abdominal obesity (86% vs 44%, p < 0.001). Apart from smoking, which was less frequent in women (27.5% vs 16%, p < 0.001), the CVD risk factors profile was more unfavourable in women compared to men. Fig. 1 shows the proportion of women

Conclusions

The study shows, in a southern European cohort of people with type 2 diabetes and no previous CVD, that women are significantly less likely than men to achieve target values for systolic blood pressure, LDL and HDL cholesterol; fasting plasma glucose and HbA1c. Obesity and central adiposity are significantly more prevalent in women, but the observed gender differences are only partially accounted for by the greater prevalence of obesity or central obesity in women; they are, in fact, more

Conflict of interest

None.

Acknowledgements

The study was supported by Foundation for Research of the Italian Society of Diabetology (Fo.Ri.SID for the research on diabetes and metabolic diseases) with unconditional grants by Astra Zeneca and Daiichi Sankyo.

We gratefully acknowledge Prof. Riccardo Giorgino and Prof. Michele Muggeo, Past Presidents Fo.Ri.SID for their continuous intellectual support since the very first phases of the study.

We gratefully acknowledge the participating centres (listed below) and the investigators of the

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Notably, T2DM women do not reach target values for major CVD risk factors, including glucose and lipid control, weight loss and reduction of inflammation and endothelial dysfunction markers as compared to men, as largely documented by international and Italian studies [54–58,25–27]. However, at variance with the international literature [58], a gender bias in the management of T2DM suggesting undertreatment of women compared with men was not observed in Italian cohorts [25–27], suggesting that other sex- (genetic, hormones) or gender-related variables (adherence, access to diabetes centers, care-givers, education, lifestyle) may be implicated. Accordingly, potential sex differences in the response to antidiabetic drugs have recently been uncovered [59,60], an issue that should be further explored, since women are typically under-represented in clinical trials.
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Microvascular and macrovascular complications of diabetes show sex- and gender-related differences, involving pathophysiological mechanisms, epidemiological features and clinical presentation, due to the interaction between biological and psychosocial factors. These differences greatly impact on the progression of diabetes and its long-term complications, especially in the cardiovascular, renal and liver districts.
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¹: On behalf of the MIND.IT Study Group of the Italian Society of Diabetology.

View full text

Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: Results from the MIND.IT Study Group of the Italian Society of Diabetology

Abstract

Background and aims

Methods and results

Conclusions

Section snippets

Methods

Statistical analyses

Results

Conclusions

Conflict of interest

Acknowledgements

Nutr Metab Cardiovasc Dis

Nutr Metab Cardiovasc Dis

J Am Coll Cardiol

Nutr Metab Cardiovasc Dis

Atherosclerosis

Am J Med

Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes

Diabetologia

Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis

Arch Intern Med

Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies

BMJ

Diabetes and decline in heart disease mortality in US adults

JAMA

Mortality trends in men and women with diabetes, 1971–2000

Ann Intern Med

Control of blood pressure and other cardiovascular risk factors at different practice settings: outcomes of care provided to diabetic women compared to men

J Clin Hypertens

Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes

Diabetes Care