Sex-specific-differences in cardiometabolic risk in type 1 diabetes: a cross-sectional study

Abstract

Background: Little is known about the impact of sex-specific differences in the management of type 1 diabetes (T1DM). Thus, we evaluated the influence of gender on risk factors, complications, clinical care and adherence in patients with T1DM.

Methods: In a cross-sectional study, sex-specific disparities in glycaemic control, cardiovascular risk factors, diabetic complications, concomitant medication use and adherence to treatment recommendations were evaluated in 225 consecutive patients (45.3% women) who were comparable with respect to age, diabetes duration, and body mass index.

Results: Although women with T1DM had a higher total cholesterol than men, triglycerides were higher in obese men and males with HbA1c>7% than in their female counterparts. No sex differences were observed in glycaemic control and in micro- or macrovascular complications. However, the subgroup analysis showed that nephropathy was more common in obese men, hyperlipidaemic women and all hypertensive patients, whereas peripheral neuropathy was more common in hyperlipidaemic women. Retinopathy was found more frequently in women with HbA1c>7%, obese men and in both sexes with a long duration of diabetes. The multivariate analysis revealed that microvascular complications were associated with the duration of disease and BMI in both sexes and with hyperlipidaemia in males. The overall adherence to interventions according to the guidelines was higher in men than in women. This adherence was concerned particularly with co-medication in patients diagnosed with hypertension, aspirin prescription in elderly patients and the achievement of target lipid levels following the prescription of statins.

Conclusions: Our data showed sex differences in lipids and overweight in patients with T1DM. Although glycaemic control and the frequency of diabetic complications were comparable between the sexes, the overall adherence to guidelines, particularly with respect to the prescription of statins and aspirin, was lower in women than in men.

Figure 1

Description of the subgroups.

Figure 2

Percentage of diabetic complications in the presence and absence of particular risk factors. The percentage of women and men with nephropathy (A), peripheral neuropathy (B) and retinopathy (C) is shown for several patient subgroups. The significance of the differences between patient subgroups in the presence and absence of particular risk factors was calculated and is indicated by asterisks (* P<0.05, ** P<0.01, *** P<0.001). 2A: The risk for the development of nephropathy increased significantly in obese men, hyperlipidaemic women and hypertensive male and female patients compared with normal weight men, normolipidaemic women and normotensive male and female patients. 2B: There was a significantly more frequent occurrence of peripheral neuropathy in hyperlipidaemic women than in normolipidaemic women. 2C: Retinopathy was observed significantly more often in male and female patients with a longer duration of disease, in women with poor glycaemic control, in obese men, and in hypertensive men and women compared with patients in the respective subgroups without these risk factors.