Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?

Harreiter, Jürgen; Fadl, Helena; Kautzky‐Willer, Alexandra; Simmons, David

doi:10.1007/s11892-020-01348-2

Cited by 29 publications

(24 citation statements)

References 69 publications

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“…In addition, some sex-specific studies found that certain risk factors and comorbidities were more potent in women 28. Diabetes mellitus, hypertension and smoking status are more strongly associated with increased risk of cardiac events in women compared with men 27 29…”

Section: Discussionmentioning

confidence: 99%

Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Yang

Wang

et al. 2022

BMJ Open

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ObjectivesTo assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI).DesignSystematic review and meta-analysis of contemporary available evidence.SettingPubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0.ParticipantsStudies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included.Primary and secondary outcome measuresThe primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up.ResultsA total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I2=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I2=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I2=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I2=74.5%).ConclusionsAn increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.

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Section: Discussionmentioning

confidence: 99%

Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Yang

Wang

et al. 2022

BMJ Open

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“…This warrants a better understanding and identification of possible factors of influence in the young diabetes population. Among adults with diabetes, sex is recognised as a potent factor of influence, leading to increased attention for a tailored approach in men and women [6][7][8]. The importance of this approach is highlighted by the fact that female individuals with type 1 diabetes have an increased risk of all-cause mortality compared with male individuals, with vascular mortality being an important contributing force [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Do sex differences in paediatric type 1 diabetes care exist? A systematic review

Vries

Verheugt

Mul³

et al. 2023

Diabetologia

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Aims/hypothesis Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. Methods Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. Results A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case–control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. Conclusions/interpretation Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes. Registration This systematic review is registered in PROSPERO (CRD42020213640) Graphical abstract

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“…Caregiving responsibilities may partially explain sex and gender differences observed in adherence and responses to adherence interventions 22,23 . For example, compared to men with diabetes, women with diabetes have higher relative cardiovascular disease mortality risk which has been linked to lower rates of medication adherence and self‐management 22 .…”

Section: Discussionmentioning

confidence: 99%

‘We tend to prioritise others and forget ourselves’: How women's caregiving responsibilities can facilitate or impede diabetes self‐management

et al. 2023

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Aim The objective of the parent study was to examine attitudes and experiences regarding counselling about preconception care among Black and/or Latina women in the United States with type 2 diabetes (T2DM). Here, we present emergent findings from a secondary analysis of caregiving. Methods In this qualitative descriptive study, we used conventional content analysis to identify themes from semi‐structured interviews with 32 Black and/or Latina women ages 18–40 who have T2DM in the United States recruited from online platforms and snowball sampling. Results Caregiving responsibilities both motivate and disrupt diabetes self‐management behaviours. Caregiving largely meant taking care of children, but women also had responsibilities to adult family members and romantic partners. Women were motivated to manage their diabetes in order to prevent negative health effects on their children and to stay healthy so they could fulfil caregiving responsibilities. However, caregiving competed for time, energy and money with self‐management. Struggling to balance caregiving and self‐management caused stress that women felt was intrinsically unhealthy and undermined self‐management. Conclusions Young adult women with T2DM identified different ways that the roles and responsibilities in the family could affect their diabetes self‐management. Providers and policymakers should develop health‐promoting interventions that accommodate caregiving responsibilities.

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Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?

Cited by 29 publications

References 69 publications

Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Do sex differences in paediatric type 1 diabetes care exist? A systematic review

‘We tend to prioritise others and forget ourselves’: How women's caregiving responsibilities can facilitate or impede diabetes self‐management

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