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Epidemiology/Health services research
Sex differences in cardiometabolic risk factors, pharmacological treatment and risk factor control in type 2 diabetes: findings from the Dutch Diabetes Pearl cohort
  1. Marit de Jong1,
  2. Marieke J Oskam2,
  3. Simone J S Sep2,
  4. Behiye Ozcan3,
  5. Femke Rutters4,
  6. Eric J G Sijbrands3,
  7. Petra J M Elders5,
  8. Sarah E Siegelaar6,
  9. J Hans DeVries6,
  10. Cees J Tack7,
  11. Marielle Schroijen8,
  12. Harold W de Valk9,
  13. Evertine J Abbink7,
  14. Coen D A Stehouwer2,
  15. Ingrid Jazet8,
  16. Bruce H R Wolffenbuttel10,
  17. Sanne A E Peters1,11,12,
  18. Miranda T Schram2
  19. Diabetes Pearl from the Parelsnoer Initiative
    1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    2. 2Department of Internal Medicine, School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
    3. 3Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
    4. 4Department of Epidemiology and Biostatistics, Amsterdam UMC - VUMC location, Amsterdam, The Netherlands
    5. 5Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, Amsterdam UMC - VUMC location, Amsterdam, The Netherlands
    6. 6Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
    7. 7Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
    8. 8Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
    9. 9Department of Internal Medicine, Universty Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    10. 10Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    11. 11The George Institute for Global Health, Imperial College London, London, UK
    12. 12The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
    1. Correspondence to Bruce H R Wolffenbuttel; bwo{at}umcg.nl

    Abstract

    Introduction Sex differences in cardiometabolic risk factors and their management in type 2 diabetes (T2D) have not been fully identified. Therefore, we aimed to examine differences in cardiometabolic risk factor levels, pharmacological treatment and achievement of risk factor control between women and men with T2D.

    Research design and methods Cross-sectional data from the Dutch Diabetes Pearl cohort were used (n=6637, 40% women). Linear and Poisson regression analyses were used to examine sex differences in cardiometabolic risk factor levels, treatment, and control.

    Results Compared with men, women had a significantly higher body mass index (BMI) (mean difference 1.79 kg/m2 (95% CI 1.49 to 2.08)), while no differences were found in hemoglobin A1c (HbA1c) and systolic blood pressure (SBP). Women had lower diastolic blood pressure (−1.94 mm Hg (95% CI −2.44 to −1.43)), higher total cholesterol (TC) (0.44 mmol/L (95% CI 0.38 to 0.51)), low-density lipoprotein cholesterol (LDL-c) (0.26 mmol/L (95% CI 0.22 to 0.31)), and high-density lipoprotein cholesterol (HDL-c) sex-standardized (0.02 mmol/L (95% CI 0.00 to 0.04)), and lower TC:HDL ratio (−0.29 (95% CI −0.36 to −0.23)) and triglycerides (geometric mean ratio 0.91 (95% CI 0.85 to 0.98)). Women had a 16% higher probability of being treated with antihypertensive medication in the presence of high cardiovascular disease (CVD) risk and elevated SBP than men (relative risk 0.84 (95% CI 0.73 to 0.98)), whereas no sex differences were found for glucose-lowering medication and lipid-modifying medication. Among those treated, women were less likely to achieve treatment targets of HbA1c (0.92 (95% CI 0.87 to 0.98)) and LDL-c (0.89 (95% CI 0.85 to 0.92)) than men, while no differences for SBP were found.

    Conclusions In this Dutch T2D population, women had a slightly different cardiometabolic risk profile compared with men and a substantially higher BMI. Women had a higher probability of being treated with antihypertensive medication in the presence of high CVD risk and elevated SBP than men, and were less likely than men to achieve treatment targets for HbA1c and LDL levels.

    • diabetes mellitus
    • type 2
    • epidemiology
    • healthcare disparities
    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    https://doi.org/10.1136/bmjdrc-2020-001365

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      Footnotes

      • MdJ and MJO contributed equally.

      • Collaborators L ‘t Hart; N C Schaper; O M Dekkers; B Silvius; M M van der Klauw.

      • Contributors MJO and MTS conceived and designed the study. MJO and MdJ analyzed the data and wrote the manuscript. SJSS, BO, FR, EJGS, PJME, SES, JHDV, CJT, MS, HWdV, EJA, CDAS, IJ, BHRW, SAEP, and MTS critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. MTS is the guarantor of this work and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

      • Funding The work described in this study was carried out in the context of the Parelsnoer Initiative (PSI). PSI is part of and is funded by the Dutch Federation of University Medical Centres and from 2007 to 2011 received initial funding from the Dutch Government. MdJ is funded by a grant from the Netherlands Organisation for Health Research and Development (ZonMw), Gender and Health Programme (80-84900-98-100). SAEP is supported by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1). The funders had no role in the design and conduct of the study; analyses and interpretation of data; or preparation, review or approval of the manuscript.

      • Competing interests None declared.

      • Patient consent for publication Not required.

      • Ethics approval The Diabetes Pearl was approved by the ethics committee of the VU University Medical Center (7 September 2009, ref: NL27783.029.09). All participants signed informed consent.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement No data are available. Proposals for collaborative research can be submitted to FR (f.rutters@vumc.nl).