Men at higher risk for diabetes-related complications than women

Key takeaways:

• Men had about a 1.5-fold increased risk for CVD, lower limb and kidney complications vs. women.
• However, high complication rates in both sexes show a need for screening and prevention strategies.

Men were at greater risk for several complications associated with type 1 and type 2 diabetes compared with women, according to results published in the Journal of Epidemiology & Community Health.

“Although the prevalence of diabetes is similar in men and women, the incidence and progression of diabetes-related complications appears to be more sex-specific,” Alice A. Gibson, BSc, APD, PhD, a research fellow at the University of Sydney, and colleagues wrote. “The evidence for sex differences in microvascular complications such as retinopathy, neuropathy and nephropathy is limited and conflicting.”

The researchers linked survey data from the 45 and Up Study — a prospective cohort study of more than 260,000 people aged 45 years and older in New South Wales, Australia — to health records of 25,713 individuals (57% men) with either type 1 or 2 diabetes.

The researchers assessed participants for the following diabetes-related complications:

• CVD complications, like ischemic heart disease, stroke or heart failure;
• lower limb complications, like cellulitis, ulcers or peripheral vascular disease;
• kidney complications, like acute kidney failure or chronic kidney disease; and
• eye complications, like diabetic retinopathy or cataract.

The overall incidence rates per 1,000 person-years for CVD, eye, lower limb and kidney complications were 37, 52, 21, and 32, respectively.

Compared with women, Gibson and colleagues found that men had greater risks for:

• CVD complications (adjusted HR = 1.51; 95% CI, 1.43-1.59);
• lower limb complications (aHR = 1.47; 95% CI, 1.38-1.57);
• kidney complications (aHR = 1.55; 95% CI, 1.47-1.64); and
• diabetic retinopathy (aHR = 1.14; 95% CI, 1.03-1.26).

Over a follow-up period of 10 years, 44% of men experienced a CVD complication, 57% experienced an eye complication, 25% had a lower limb complication and 35% had a kidney complication.

In comparison, 31% of women had a CVD complication, 61% had an eye complication, 18% had a lower limb complication and 25% had a kidney complication.

The researchers noted that whether individuals had diabetes for more or less than 10 years had no effect on sex differences in complications.

Regarding possible mechanisms behind the findings, Gibson and colleagues pointed out that men in the study were more likely to have multiple risk factors, including overweight, a history of heart disease or stroke and a history of smoking.

“Men may also be less likely to adopt primary prevention strategies, such as healthy lifestyle change and medication use, and to engage in health seeking behaviors, such as preventative health checks,” they wrote. “Further, women are known to be at lower risk of CVD complications compared with men due to the protective effects of reproductive factors such as breastfeeding and the use of hormone replacement therapy within 10 years of menopause.”

There were some limitations. The researchers did not account for possible factors like glycemic, lipid and BP control, and people with prior complications were excluded from the study.

Ultimately, the finding that complication rates were high in both men and women “highlights the need for targeted complication screening and prevention strategies from the time of diabetes diagnosis,” Gibson and colleagues concluded. “Further investigation into the underlying mechanisms for the observed sex differences in diabetes complications are needed to inform targeted interventions.”