Influence of Gender on Cardiovascular Risk and Glycemic Control in T1D

When assessing sex differences in young adults with type 1 diabetes, women may experience less favorable results regarding glycemic control and prevalence of cardiovascular risk factors compared with men, according to a study published in Endocrine.

Researchers performed a cross-sectional, single-center, observational, prospective study of 300 patients (men=168; women=132) with a mean age of 24.7 years in Naples, Italy, currently participating in the Management and Technology for Transition (METRO) study, in an effort to assess differences in glycemic control, major cardiovascular risk factors, diabetes-related complications, sexual dysfunction prevalence, and endothelial function between young men and women with type 1 diabetes transitioning from a pediatric clinic to an adult diabetes care center

Study results found women to have higher glycated hemoglobin (HbA_1c; 8.4%±1.3% vs 8.1%±1.3%; P =.020), as well as poorer glycemic control (HbA_1c >8%) compared with men (61% vs 44%; P = .004). HbA_1c between 7% and 7.9% (P =.008) was noted more often in men, whereas more women had HbA_1c >9% (P =.017). However, after insulin delivery devices were analyzed, women were found to have higher HbA_1c and high blood glucose index compared with men when treated with multiple daily injections of insulin (8.3%±1.3% vs 7.8%±1.2% [P =.027]; 8.2±4.1 vs 6.9±3.4 [P =.023], respectively).

Women were found to have a higher body mass index and prevalence of obesity when compared with men (kg/m²; 24.8±4.2 vs 23.9±3.9 [P =.034]; 41% vs 25.5% [P =.007], respectively). In addition, high-density lipoprotein cholesterol levels (mg/dL, 61.7±13.7 vs 54.7±13.9; P <.001) and percentage of autoimmune thyroiditis (37% vs 15%; P <.001) were also higher in women compared with men, whereas hypertension and hyperlipidemia were similar between men and women. Men were found to have higher smoking prevalence and sexual dysfunction compared with women (25.5% vs 13% [P <.001]; 35.7% vs 19% [P <.001], respectively). Women had lower counts of both CD133⁺KDR and CD34⁺KDR⁺CD133⁺ endothelial progenitor cells (P =.022 and P <.001, respectively).

The researchers concluded that women appeared to have an increased vulnerability to obesity, poor glycemic control, and autoimmune thyroiditis, whereas men were more likely to experience sexual dysfunction and more frequently to smoke. In addition, researchers found “differences with regard to diabetes control and glucose variability in patients treated with multiple daily injection, but not with [continuous subcutaneous insulin infusion], suggesting that young women with type 1 diabetes may have a different attitude in managing their diabetes according to the prescribed insulin regimen.” Therefore, clinicians should continue to improve the care and management of diabetes in young adults, especially in women, and consider alternative insulin delivery methods to increase diabetes management adherence.           

Reference

Maiorino MI, Bellastella G, Casciano O, et al. Gender-differences in glycemic control and diabetes related factors in young adults with type 1 diabetes: results from the METRO study [published online February 17, 2018]. Endocrine. doi: 10.1007/s12020-018-1549-9