Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

Xu, Guodong; You, Dingyun; Wong, Li Ping; Duan, Donghui; Kong, Fansen; Zhang, Xiaohong; Zhao, Jinshun; Wu, Xing; Han, Liyuan; Li, Li

doi:10.1530/eje-18-0792

Cited by 40 publications

(20 citation statements)

References 91 publications

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“…Similarly, a UK RCT in Type 2 diabetics found that women had an 88% increased risk over men of declining to <60 mL/min/1.73 m 2 [ 43 ]. Moreover, excess mortality risk in diabetic women has been described in the dialysis population [ 44 ] as well as in non-renal cohorts [ 45 , 46 ], confirming a disproportional negative impact of diabetes in women. Diminished protection of oestrogens in the hyperglycaemic state may explain this disparate effect, even though the women in our population were likely post-menopausal [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Renal function decline in older men and women with advanced chronic kidney disease—results from the EQUAL study

Chesnaye

Dekker

Evans

et al. 2020

Nephrology Dialysis Transplantation

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Introduction Understanding the mechanisms underlying the differences in renal decline between men and women may improve sex-specific clinical monitoring and management. To this end, we aimed to compare the slope of renal function decline in older men and women in chronic kidney disease (CKD) Stages 4 and 5, taking into account informative censoring related to the sex-specific risks of mortality and dialysis initiation. Methods The European QUALity Study on treatment in advanced CKD (EQUAL) study is an observational prospective cohort study in Stages 4 and 5 CKD patients ≥65 years not on dialysis. Data on clinical and demographic patient characteristics were collected between April 2012 and December 2018. Estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration equation. eGFR trajectory by sex was modelled using linear mixed models, and joint models were applied to deal with informative censoring. Results We included 7801 eGFR measurements in 1682 patients over a total of 2911 years of follow-up. Renal function declined by 14.0% [95% confidence interval (CI) 12.9–15.1%] on average each year. Renal function declined faster in men (16.2%/year, 95% CI 15.9–17.1%) compared with women (9.6%/year, 95% CI 6.3–12.1%), which remained largely unchanged after accounting for various mediators and for informative censoring due to mortality and dialysis initiation. Diabetes was identified as an important determinant of renal decline specifically in women. Conclusion In conclusion, renal function declines faster in men compared with women, which remained similar after adjustment for mediators and despite a higher risk of informative censoring in men. We demonstrate a disproportional negative impact of diabetes specifically in women.

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Section: Discussionmentioning

confidence: 99%

Renal function decline in older men and women with advanced chronic kidney disease—results from the EQUAL study

Chesnaye

Dekker

Evans

et al. 2020

Nephrology Dialysis Transplantation

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“…In general, the absolute risk for T2DM and CVD mortality is higher in men; however, the relative risk of all-cause and CVD mortality in women with T2DM has consistently been reported to be significantly higher and was also reported in women with T1DM (Table 1 ) [ 12 •, 19 , 20 , 21 •, 22 , 23 ]. Higher risks were observed in younger groups with diabetes compared with older groups with the highest risk found in women with diabetes between 35 and 59 years of age [ 22 ].…”

Section: Increased Mortality Risk In Women With Diabetes?mentioning

confidence: 99%

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

et al. 2020

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Purpose of Review This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. Recent Findings In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. Summary The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.

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“…[1][2][3] Diabetes mellitus is associated with a twofold to fourfold increase in mortality, compared with the general population. [4][5][6] Cardiovascular (CV) mortality seems to be a major determinant of all-cause mortality. 4 6 The most extensively studied…”

Section: Introductionmentioning

confidence: 99%

Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study

Sütó

Molnár

Rokszin³

et al. 2021

BMJ Open Diab Res Care

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IntroductionMortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied.Research design and methodsPatients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model.ResultsAfter propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference.ConclusionsSGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.

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Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

Cited by 40 publications

References 91 publications

Renal function decline in older men and women with advanced chronic kidney disease—results from the EQUAL study

Renal function decline in older men and women with advanced chronic kidney disease—results from the EQUAL study

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

Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study

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