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Structured Personal Diabetes Care Reduced Mortality Rates in Women, Not Men

New study showed women accept disease, implement disease management more easily.

Type 2 diabetes is associated with significant morbidity and mortality because of its complications, such as cardiovascular disease and renal dysfunction. For diabetic patients, self-monitoring glucose levels and having a good lifestyle are critical to controlling their glycemic level. However, sex-related differences in lifestyle may lead to differences in the risk of developing diabetes complications since the bodies of men and women are of course not the same.

The prevalence of type 2 diabetes was higher among men. Because of differences in physiology, researchers recommended doctors treat diabetic patients in accordance to their gender. A follow-up study revealed personally tailored diabetes care in general practice could reduce all-cause mortality and diabetes-related death in women, but not in men. This study was published in the Journal of the European Association for the Study of Diabetes (EASD).

The aim of this study was to assess gender differences in mortality and morbidity during 13 follow-up years after six years of structured personal care in patients with type 2 diabetes mellitus.

This study was conducted by Dr. Marlene Krag of the University of Copenhagen in the research unit for general practice. Researchers recruited 1,381 patients who were newly diagnosed with type 2 diabetes, and participants were randomized to receive six years of either structured personal care or routine care. After six years, 970 patients survived and were included in the analysis, about half of them were women. In the trial, participants in the intervention group received diabetic education, such as the importance of diet and physical activity. Doctors reviewed patients’ individual targets quarterly. People in the routine care group could manage their disease in the way they liked. This study focused on all-cause mortality, incidence of diabetes-related death, and any diabetic complications, like myocardial infarction, stroke, and peripheral vascular disease.

The results showed women in the structured personal care group were 26 percent less likely to die of any cause and 30% less likely to die of a diabetes-related cause, compared with women given routine care. The reduction of glycated hemoglobin was also found in women after six years. In addition, women given the personal care intervention were also 41 percent less likely to suffer a stroke, and 35 percent less likely to have any diabetes-related endpoint, but the results of any diabetes-related endpoint, diabetes-related death, and all cause mortality were not statistically significant. Surprisingly, those findings also were observed in women, but not in men. Compared with the results of men and women, the effect was statistically significant between men and women for diabetes-related death and all-cause mortality.

While discussing the cause of gender difference in the management of type 2 diabetes, Dr. Krag added, “structured personal diabetes care could provide women with significant attention and support and thus provide an incentive to treatment adherence. Women accept disease and implement disease management more easily, which might affect long-term outcomes.” The study also mentioned the structured approach might conflict with men’s tendency to trust self-directed learning instead of self-management. Gender differences in the management and control of diabetes has been studied in the past. Geer et al. suggested the abdominal visceral fat is linked to the cause of diabetes, and body fat distribution differs by sex. In addition, obesity is one of the main risk factors for type 2 diabetes. They also pointed out in general men have more abdominal fat, and women have more peripheral fat.

These observational results from a post-hoc analysis of a randomized controlled trial cannot be explained by intermediate outcomes like HbA1c alone, but involves complex social and cultural issues of gender. There is a need to rethink treatment schemes for both men and women to gain benefit from intensified treatment efforts.

In conclusion, this study accessed the outcome of diabetic care in different gender. The author believed the improved outcomes in women may be explained by complex social and cultural issues of gender.

Practice Pearls:

  • A follow-up study of patients with diabetes in Denmark accessed the different outcomes of personally tailored diabetes care in women and men.
  • The results showed only women in the structured personal care group were 26 percent less to die of any cause and 30% less likely to die of a diabetes-related cause.
  • The result of study could be explained by the complex social and cultural issues of gender.

 

Marlene Ø. Krag, Lotte Hasselbalch, Volkert Siersma, Anni B. S. Nielsen, Susanne Reventlow, Kirsti Malterud, Niels de Fine Olivarius. The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study. Diabetologia, 2015

Geer EB, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend.Med 6 Suppl 1: 60-75