Sex differences in cardiometabolic risk factors, pharmacological treatment and risk factor control in type 2 diabetes: findings from the Dutch Diabetes Pearl cohort

Abstract

IntroductionSex differences in cardiometabolic risk factors and their management in type 2 diabetes (T2D) have not been fully identified. Therefore, we aimed to examine differences in cardiometabolic risk factor levels, pharmacological treatment and achievement of risk factor control between women and men with T2D.Research design and methodsCross-sectional data from the Dutch Diabetes Pearl cohort were used (n=6637, 40% women). Linear and Poisson regression analyses were used to examine sex differences in cardiometabolic risk factor levels, treatment, and control.ResultsCompared with men, women had a significantly higher body mass index (BMI) (mean difference 1.79 kg/m2 (95% CI 1.49 to 2.08)), while no differences were found in hemoglobin A1c (HbA1c) and systolic blood pressure (SBP). Women had lower diastolic blood pressure (−1.94 mm Hg (95% CI −2.44 to −1.43)), higher total cholesterol (TC) (0.44 mmol/L (95% CI 0.38 to 0.51)), low-density lipoprotein cholesterol (LDL-c) (0.26 mmol/L (95% CI 0.22 to 0.31)), and high-density lipoprotein cholesterol (HDL-c) sex-standardized (0.02 mmol/L (95% CI 0.00 to 0.04)), and lower TC:HDL ratio (−0.29 (95% CI −0.36 to −0.23)) and triglycerides (geometric mean ratio 0.91 (95% CI 0.85 to 0.98)). Women had a 16% higher probability of being treated with antihypertensive medication in the presence of high cardiovascular disease (CVD) risk and elevated SBP than men (relative risk 0.84 (95% CI 0.73 to 0.98)), whereas no sex differences were found for glucose-lowering medication and lipid-modifying medication. Among those treated, women were less likely to achieve treatment targets of HbA1c (0.92 (95% CI 0.87 to 0.98)) and LDL-c (0.89 (95% CI 0.85 to 0.92)) than men, while no differences for SBP were found.ConclusionsIn this Dutch T2D population, women had a slightly different cardiometabolic risk profile compared with men and a substantially higher BMI. Women had a higher probability of being treated with antihypertensive medication in the presence of high CVD risk and elevated SBP than men, and were less likely than men to achieve treatment targets for HbA1c and LDL levels.

Sex Differences in Lipid Profile across the Life Span in Patients with Type 2 Diabetes: A Primary Care-Based Study

“…Sex differences in LDL-c levels in T2D have previously been reported, with women having higher levels than men [ 16 , 22 , 26 ]. These studies did not allow for conclusions regarding age-dependent effects.…”

“…Recent meta-analyses showed that T2D poses a 44% greater excess risk for coronary heart disease and a 27% greater excess risk for stroke in women compared to men [ 14 , 15 ]. Sex differences in the lipid profile are likely to play a role in this, since women with T2D have higher LDL-c and HDL-c levels and lower triglyceride (TG) levels than men with T2D [ 16 ]. It is not clear, however, whether such differences are present across all age groups and if they are influenced by menopausal status.…”

“…Since T2D increases the risk of CVD in women more than in men, women should be treated at least as stringently as men [ 6 ]. Nonetheless, it seems that women with T2D are treated less aggressively with statins [ 21 , 22 , 23 ] and achieve cholesterol treatment targets less often than men [ 16 , 21 , 22 , 24 , 25 , 26 , 27 ].…”

Prevalence of Selected Risk Factors for Cardiometabolic Disease among University Staff in the Western Cape, South Africa

“…Our study revealed a high prevalence, by risk level, for abdominal obesity, waist-to-hip ratio, and waist-toheight ratio among the studied participants, especially women. Women seem to have been severely implicated when it comes to gender differences with a high prevalence of cardiometabolic risk globally being one of the major factors behind disability-adjusted life-years (DALY) lost [21]. Although, de Jong et al [22] reported that cardiometabolic risk features in females might not be the same when compared to their male counterparts due to the higher body mass index regularly noticed in females.…”

Sex and ethnic differences in the cardiovascular complications of type 2 diabetes

“…Specifically, women with T2D had worse clinical (waist circumference, BMI, diastolic BP) and biochemical markers of inflammation (white blood cell count), lipids, insulin resistance and coagulation (von Willebrand factor, factor VIII) compared with men. 32 Furthermore, consistent reports of poorer modifiable risk factor profile in women with T2D, especially greater obesity and lower achievement of glycaemia and lipid targets, have been seen in multiple countries including Italy, 33 Netherlands, 34 and the United States (US). 35 Interestingly, all these studies reported that utilisation of lipid-lowering, glucose-lowering and anti-hypertensive medication among women were either greater than or comparable with men.…”