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

Abstract

Introduction: Sex 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 methods: Cross-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.

Results: Compared 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 A_1c (HbA_1c) 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 HbA_1c (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.

Conclusions: In 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 HbA_1c and LDL levels.

Keywords: diabetes mellitus; epidemiology; healthcare disparities; type 2.

Figure 1

Age-adjusted women-to-men mean differences of cardiometabolic risk factor levels. A mean difference in BMI of 1.79 kg/m² means that the age-adjusted BMI in women is 1.79 kg/m² higher than in men. Back transformation of log-transformed triglycerides results in a geometric mean ratio of 0.91 (95% CI 0.85 to 0.98). Men: reference. BMI, body mass index; DBP, diastolic blood pressure; HbA_1c, hemoglobin A_1c; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TC, total cholesterol.

Figure 2

Pharmacological treatment and achievement of treatment targets of hyperglycemia (upper panel), hypertension (middle panel) and dyslipidemia (lower panel) in percentages for women and men. No treatment and no indication: no medication use and no indication for treatment (risk factor below cut-off or either low or medium 10-year CVD risk in case of SBP >140 mm Hg or LDL-c >2.5 mmol/L); optimal treatment: medication use and risk factor below cut-off; suboptimal treatment: medication use and risk factor above cut-off; no treatment despite indication: no medication use, but HbA_1c>53 mmol/mol or high 10-year CVD risk and SBP >140 mm Hg or LDL-c >2.5 mmol/L. CVD, cardiovascular disease; HbA_1c, hemoglobin A_1c; LDL-c, low-density lipoprotein cholesterol; SBP, systolic blood pressure.

Figure 3

Age-adjusted women to men risk ratios with 95% CI for treatment of cardiometabolic risk factors according to risk factor levels and 10-year CVD risk score. Men and women refer to the total number of participants included in the analyses, and % refers to the number of participants not receiving glucose-lowering, antihypertensive or lipid-modifying medication. Men: reference. CVD, cardiovascular disease; HbA_1c; hemoglobin A_1c; LDL-c, low-density lipoprotein cholesterol; SBP, systolic blood pressure.