Sex-Gender Differences in Diabetic Retinopathy

Abstract

Diabetic retinopathy (DR) is one of the main causes of visual loss in individuals aged 20–64 years old. The aim of this study was to investigate, in a multicenter retrospective cross-sectional study, sex-gender difference in DR in a large sample of type 2 diabetic patients (T2DM). 20,611 T2DM regularly attending the units for the last three years were classified as having: (a) No DR (NDR), (b) nonproliferative DR (NPDR), or (c) preproliferative/proliferative DR (PPDR). DR of all grades was present in 4294 T2DM (20.8%), with a significant higher prevalence in men as compared to women (22.0% vs. 19.3% p < 0.0001). Among DR patients, both NPDR and PPDR were significantly more prevalent in men vs. women (p = 0.001 and p = 0.0016, respectively). Women had similar age and BMI, but longer diabetes duration, worse glycemic metabolic control, and more prevalence of hypertension and chronic renal failure (CRF) of any grade vs. men. No significant differences between sexes were evident in term of drug therapy for diabetes and associate pathologies. Conclusions: In this large sample of T2DM, men show higher prevalence of DR vs. women, in spite of less represented risk factors, suggesting that male sex per se might be a risk factor for DR development.

Prevalence of diabetic retinopathy in patients with newly diagnosed type 2 diabetes: A systematic review and meta‐analysis

“…Moreover, our meta‐regression showed that the proportion of female patients of study populations is significantly correlated with lower DR prevalence among patients with newly diagnosed T2DM. This finding supports previous studies that suggest men show a higher prevalence of DR versus women, indicating that male sex per se might be a risk factor for DR development 97 . Our univariate meta‐regression analysis was unable to demonstrate a significant association between the mean age of patients and the prevalence of established DR in patients with newly diagnosed T2DM.…”

Lower Risk of Incident Cataracts and Diabetic Retinopathy amongst Individuals Treated with Sodium Glucose Cotransporter-2 Inhibitor Compared to Dipeptidyl Peptidase-4 Inhibitor in Type 2 Diabetes Mellitus

“…It was also found that male and females using DPP4I had a higher risk of incident diabetic retinopathy than SGLT2I users, but within each drug group, males had a higher risk than females. Epidemiology studies have recognised that the male gender is an independent risk factor for developing diabetic retinopathy (42). It was also found that males and females using DPP4I had a higher risk of incident diabetic retinopathy than SGLT2I users, but within the DPP4I group, males had a higher association within developing new diabetic retinopathy, whereas in the SGLT2I group women had a slightly higher association with developing new diabetic retinopathy ( Figure 2F ).…”

“…It was also found that males and females using DPP4I had a higher risk of incident diabetic retinopathy than SGLT2I users, but within the DPP4I group, males had a higher association within developing new diabetic retinopathy, whereas in the SGLT2I group women had a slightly higher association with developing new diabetic retinopathy ( Figure 2F ). Epidemiology studies which found that male sex is an independent risk factor of the development of diabetic retinopathy ( Figure 2C ) (42). Potential reasons for this include alterations in ocular blood flow regulation mediated by sex hormones and inflammatory cytokine profiles variations due to sex, in particular oestrogen in women having a vasodilating effect and testosterone in men having a vasoconstrictive effect potentially worsening diabetic retinopathy (42, 43).…”

“…Epidemiology studies which found that male sex is an independent risk factor of the development of diabetic retinopathy ( Figure 2C ) (42). Potential reasons for this include alterations in ocular blood flow regulation mediated by sex hormones and inflammatory cytokine profiles variations due to sex, in particular oestrogen in women having a vasodilating effect and testosterone in men having a vasoconstrictive effect potentially worsening diabetic retinopathy (42, 43). Therefore it was interesting to note in the SGLT2I group that women had a higher association with new diabetic retinopathy, and possibly coule be explained by a modulating effect of SGLT2I though much further and in depth work will need to be done to investigate this further.…”

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non- ST Elevation Myocardial Infarction

“…2 Diabetes Mellitus is a heterogeneous primary disorder of carbohydrate metabolism with absolute insulin deficiency (Type 1) or relative insulin deficiency (type 2), resistance or both leading to hyperglycemia. 3 The South Asian region shares a major proportion of this worldwide burden of diabetes. The prevalence of diabetes ranges from 0.9% in Bangladesh to 21.2% in india.…”