EASD: Type 2 Diabetes Less Prevalent in Women But Just as Deadly

AMSTERDAM, Sept. 20 -- Men are up to two and a half times more likely to have newly diagnosed type 2 diabetes than women, but once a woman is diagnosed, the disease is just as deadly for them asfor men.

Those conclusions emerged from two European studies presented at the meeting of the European Association for the Study of Diabetes here.

Agneta Hilding, M.D., of the Karolinska Institute in Stockholm, and colleagues, had previously reported that men have a higher overall risk for type 2 diabetes. In their follow-up study they examined whether the difference in risk was affected by menopause.

Dutch researchers, meanwhile, said that data from the 1,145 patient ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study found that the all cause mortality ratio was 2.15 for women (95% confidence interval, 1.85 to 2.49) compared with 1.75 (95% CI 1.48 to 2.05) for men (P=0.83).

Dr. Hilding and colleagues evaluated data from 2,383 men and 3,329 women who had participated in the baseline study from 1992 through 1994 and were available for follow-up from 2003 through 2004. The participants had no known diabetes, and all underwent new oral glucose challenge testing and filled out questionnaires regarding lifestyle. Women were also asked about menopausal status and use of hormone replacement therapy.

At baseline, 38% of the women were pre-menopausal and 16% were postmenopausal and had not taken hormone replacement therapy. At follow-up, 10% had still not entered menopause and 38% were postmenopausal and not taken hormone replacement therapy.

Diabetes prevalence was higher in men at both baseline and follow-up. At baseline, 2.1% of men versus 1.3% of women had newly diagnosed type 2 diabetes, a 1.6-fold difference. Similarly, at follow-up, 4.2% of men were newly diagnosed with diabetes versus 1.7% of women.

At both time points there were similar differences between the sexes in impaired fasting glucose and/or impaired glucose tolerance.

Incident diabetes - disease newly diagnosed between baseline and follow-up - was 3.5% in men compared with 1.4% in women.

In an analysis controlling for menopausal status, the authors found that there were no interactions between menopause and type diabetes.

In the ZODIAC study Gijs W.D. Landman, M.D., of the Isala Clinics in Zwolle, the Netherlands, and colleagues, compared mortality among 1,145 patients with type 2 diabetes to mortality in the general population.

Dr. Landman said that although women generally have a survival advantage over men, "type 2 diabetes eliminates the relative protection against death in women."

The ZODIAC study researchers evaluated mortality rates in male and female patients using standardized mortality ratios, and created Cox proportional hazard models to examine the association of death with established risk factors, including age, duration of diabetes, smoking status, glycosylated hemoglobin A1c (HbA1c) levels, estimated glomerular filtration rate as a measure of renal function, BMI, cholesterol/HDL ratio, and the presence or absence of macrovascular complications.

When they assessed standardized mortality ratios, the authors found that the all-cause mortality ratio was 2.15 for women (95% confidence interval, 1.85 to 2.49) compared with 1.75 (95% CI 1.48 to 2.05) for men, but this difference was not statistically significant (P=0.83).

Among women, risk factors associated with increased risk of mortality were age (hazard ratio 1.11, 95% CI 1.09 to 1.14), HbA1c (HR1.25, 95% CI, 1.12 to 1.41), and macrovascular complications (HR 1.91, 95% CI 1.36 to 2.70).

Among men, the risk factors significantly associated with mortality were age (HR 1.06, 95% CI 1.03 to 1.09), smoking (HR 1.78, 95% CI 1.23 to 2.57), estimated glomerular filtration rate (HR, 95% CI 0.96 to 0.99), and macrovascular complications (HR 1.51, 95% CI 1.00 to 2.28).

"This study confirms that diabetes management should not be gender specific, and that women should be treated as aggressively as men," Dr. Landman said.