Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes

Abstract

OBJECTIVETo investigate the quality of type 2 diabetes care according to sex.RESEARCH DESIGN AND METHODSClinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated.RESULTSOverall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c >9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10–1.17]), 42% more likely to have LDL cholesterol (LDL-C) ≥130 mg/dL (1.42 [1.38–1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 kg/m2 (1.50 [1.50–1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure.CONCLUSIONSWomen show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.

Young FADOI and gender medicine: sex gender differences in cardiovascular disease

“…76 Besides innate differences in sex physiology, disparities between sexes in the treatment of major cardiovascular risk factors also exist. 77 These can be attributed to an underestimation of patient risk and a less aggressive approach and poorer compliance of females. 71 Nevertheless, two Italian studies did not find any relevant differences between females and males in terms of the quality of diabetes care, [77][78][79] suggesting that factors other than gender disparities in treatment intensity are responsible.…”

Sex/Gender -Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes

“…A recent systematic review and meta-analysis of 64 cohorts, including 858,507 individuals and 28,203 coronary events, reported women with diabetes have more than a 40% greater risk of incident coronary heart disease compared with men with diabetes [29]. The cause of these significant disparities may partially stem from lack of control for cardiovascular risk factors including low-density lipoprotein (LDL) cholesterol among female patients with diabetes [11,13,27,30,33]. A cross-sectional study of 680 patients with diabetes reported mean systolic BP and LDL cholesterol levels were significantly higher in women.…”

“…Hormonal influences can play an important role [14,15]; for example, as a result of fluctuations in concentrations of sexual steroids, and subsequently changes in total body water, sex/gender-specific differences in the plasma levels of drugs can be observed [38]. Sex/gender differences in dyslipidemia treatment with statins and the greater difficulty in reaching the targets can be partially related to the sex/gender physiopathological differences [13]; for example, sex/gender differences is diverse drug responses between women and men due to dissimilarities in pharmacodynamics and pharmacokinetics [14,15]. Evidence supporting sex-based differences in statin metabolism implicates differences in body-fat content between men and women [16].…”

“…Cardiovascular disease continues to be a significant factor for increased morbidity and mortality in people with diabetes [1,2,25,26] and disparities in outcomes for cardiovascular disease exist between men and women with diabetes [9,11,13,27,28]. A recent systematic review and meta-analysis of 64 cohorts, including 858,507 individuals and 28,203 coronary events, reported women with diabetes have more than a 40% greater risk of incident coronary heart disease compared with men with diabetes [29].…”

“…For dyslipidemia treatment in patients with diabetes, sex/gender disparities have been illustrated in several studies [12]. Sex/ gender differences in dyslipidemia treatment with statins and the greater difficulty in reaching targets may be related to the use of a less aggressive approach in women, poorer adherence of women to statins or sex/gender physiopathological differences [13]. An example of pathophysiological data on sex/gender differences is diverse drug responses between women and men due to dissimilarities in pharmacodynamics and pharmacokinetics [14,15]; for instance, evidence supporting sex/genderbased differences in statin metabolism implicates differences in body-fat content between men and women [16].…”