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Gender Differences in Control of Multiple CVD Risk Factors in Type 2 Diabetes Patients

Adjusted mean DBP levels found to be significantly higher in women compared to men but other risk factors were almost the same between genders….

Williams and colleagues conducted a cross-sectional study in which patients were randomly recruited from three primary care clinics in the southeastern US and asked to complete a self-report survey yielding data relevant to gender differences in CVD risk factor control. The primary outcomes were individual diabetes-related risks which were defined as not having an HbA1c level <7%, BP of <130/80 mm Hg, and LDL<100 mg/dl, and composite control defined as having all three outcomes under control simultaneously.

Of the T2DM patients enrolled, 56% were men, 67% were non-Hispanic black, and 78% made less than $35,000 per year. Unadjusted mean SBP (134 mmHg vs. 13 mmHg, p = 0.005) and LDL cholesterol levels (99.7mg/dL vs. 87.6mg/dL, P<0.001) were much higher in women than in men; however, after adjusting for relevant confounders, differences in SBP and LDL cholesterol levels were not significant. However, adjusted mean DBP levels were found to be significantly higher in women compared to men (β = 3.09, 95% CI = 0.56-5.63). Regarding the gender differences in composite control, the results showed that women had poorer control of multiple CVD risk outcomes than men (β = 2.90, 95% CI = 1.37-6.13). Other primary outcomes were not statistically significantly different, including glycemic control in both genders.

Limitations in this study included the fact that the cross-sectional study design does not prove causal associations. Also, confounders not controlled for included diabetes knowledge, self-management practices, medication adherence, co-morbidity burden, social support, duration of diabetes, medications used to treat diabetes, and hypertension. In addition, high triglyceride level was an independent risk factor for coronary heart disease, particularly for women.         

In conclusion, further study is needed. In the meantime, both sexes need to be encouraged to adopt healthy lifestyle habits.

Practice Pearls:
  • Women with type 2 diabetes had poorer control of multiple CVD risk outcomes than men.
  • Adjusted mean DBP levels were found to be significantly higher in women compared to men.
  • Women with T2DM should be educated on how to be aware of and modify their risk factors, and adopt a healthy life style to improve better outcomes.

References: Williams J, Lunch C, Winchester R, et al. Gender Differences in Composite Control of Cardiovascular Risk Factors Among Patients with Type 2 Diabetes. Diabetes Technology & Therapeutics. 2014.16(7):421-427.