Type 1 Women Have A 40% Greater Risk of Mortality than Men

In the meta-analysis, women also had twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes…

Australian researchers have done a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes.

The researchers searched PubMed for studies published between Jan 1, 1966 and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. They used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes.

Data from 26 studies including 214,114 individuals and 15,273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1.37 (95% CI 1.21–1.56), for incident stroke 1.37 (1.03–1.81), for fatal renal disease 1.44 (1.02–2.05), and for fatal cardiovascular diseases 1.86 (1.62–2.15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2.54 (95% CI 1.80–3.60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide.

Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes.

Practice Pearls:

• Women-to-men ratio of the standardized mortality ratio (SMR) for all-cause mortality was 40% greater.
• Research into racial and ethnic differences and improved cardiovascular risk prediction methods in this patient group was needed.
• Health and funding systems should systematically support improvements in glycemic control from diagnosis, for all patients with type 1 diabetes, through tailored therapy as implemented in the DCCT, including mental health support and personalized strategies that help avoid hypoglycemia.

1 – Huxley R “Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis” Lancet Diabetes Endocrinol 2015; DOI: 10.1016/S2213-8587(14)70248-7.
2 – Simmons D “Excess deaths in women with type 1 diabetes: time to act” Lancet Diabetes Endocrinol 2015; DOI: 10.1016/S2213-8587(14)70272-4. reported in The Lancet Diabetes & Endocrinology.