Highlights:
- Men had approximately 1.5 times higher risk of CVD, lower limb, and kidney complications compared with women.
- However, the high complication rates in both men and women indicate the need for screening and prevention strategies.
Men are at higher risk of several complications related to type 1 and type 2 diabetes than women, according to a study published in the Journal of the American Heart Association. Journal of Epidemiology and Community Health.
“Although the prevalence of diabetes is similar in men and women, the incidence and progression of diabetes-related complications appear to differ between the sexes.” Alice A. Gibson, BSc, APD, PhD, “Evidence regarding sex differences in microvascular complications, including retinopathy, neuropathy, and nephropathy, is limited and conflicting,” the University of Sydney researchers and colleagues wrote.
Researchers linked survey data from the 45 and Up Study, a prospective cohort study of more than 260,000 people aged 45 years or older in New South Wales, Australia, with the health records of 25,713 people (57% men) with type 1 or type 2 diabetes.
The researchers assessed participants for the following diabetes-related complications:
- CVD complications such as ischemic heart disease, stroke, and heart failure.
- Lower extremity complications including cellulitis, ulcers, and peripheral vascular disease.
- Kidney complications such as acute kidney failure or chronic kidney disease
- Eye complications such as diabetic retinopathy and cataracts.
The overall incidence rates per 1000 person-years for CVD, eye, lower limb, and renal complications were 37, 52, 21, and 32, respectively.
Gibson and his colleagues found that compared with women, men were at higher risk for:
- CVD complications (adjusted HR = 1.51; 95% CI, 1.43-1.59)
- Lower extremity complications (aHR = 1.47, 95% CI, 1.38-1.57)
- renal complications (aHR = 1.55; 95% CI, 1.47-1.64) and
- diabetic retinopathy (aHR = 1.14; 95% CI, 1.03-1.26);
During the 10-year follow-up period, 44% of men experienced CVD complications, 57% experienced ocular complications, 25% experienced lower extremity complications, and 35% experienced renal complications.
In comparison, 31% of women had CVD complications, 61% had eye complications, 18% had lower extremity complications, and 25% had renal complications.
The researchers noted that having diabetes for more or less than 10 years did not affect gender differences in complications.
Regarding the possible mechanism behind the findings, Gibson and his colleagues pointed out that the men in the study were likely to have multiple risk factors, such as being overweight, having a history of heart disease or stroke, or a history of smoking.
“Men may be less likely to adopt primary prevention strategies, such as healthy lifestyle changes and medication use, or to engage in health-seeking behaviors, such as preventive health screening,” they write. “Furthermore, women are known to be at lower risk of CVD complications compared to men, due to the protective effects of reproductive factors, such as breast-feeding and use of hormone replacement therapy within 10 years of menopause.”
There were some limitations: The researchers didn't take into account factors such as blood sugar, lipid or blood pressure control, and people with previous comorbidities were excluded from the study.
Ultimately, the finding that complication rates were higher in both men and women “highlights the need for targeted complication screening and prevention strategies beginning from the time of diabetes diagnosis,” Gibson and colleagues concluded. “Further investigation of the mechanisms underlying the observed sex differences in diabetes complications is warranted in order to develop targeted interventions.”