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Men with diabetes (either type 1 or type 2) face a greater risk of complications than women, regardless of diabetes duration, according to data published today in the Journal of Epidemiology & Community Health.

Specifically, researchers reported that men with diabetes had a greater risk of cardiovascular disease (CVD), lower limb and kidney complications, and diabetic retinopathy compared to women, and the sex differences in risk of complications were similar whether diabetes duration was more or less than 10 years.

The global prevalence of diabetes is similar between men and women (8.9% and 8.4%, respectively), but “the incidence and progression of diabetes-related complications appears to be more sex-specific,” investigators wrote. “It is well established that the absolute risk of [CVD] is higher in men with diabetes than women with diabetes.”

Less is known, however, about sex differences in microvascular complications and the impact of diabetes duration on sex differences. To explore these gaps in research, investigators assessed survey responses from the 45 and Up Study, a large prospective study of 267 357 men and women aged over 45 years living in New South Wales, Australia. These responses were linked to medical records, according to the study.

Participants were excluded from the current study if they did not have diabetes at baseline, had an uncertain diabetes status, or there were inconsistencies in their age, death, or baseline data. The final sample included 25 713 individuals with diabetes at baseline. Nearly half of the cohort was aged 60 to 74 years and 57% were men. A higher proportion of men were overweight compared to women (38.7% vs 27.8%) and had a history of CVD. Of the 19 277 participants whose age was recorded at the time of diagnosis, 58% had a duration of diabetes less than 10 years and 42% had a duration of 10 or more years at baseline.

Diabetes-related complications included CVD (eg, ischemic heart disease, stroke, heart failure, diabetic cardiomyopathy, transient ischemic attack [TIA], eye issues (eg, diabetic retinopathy, cataract), lower limb issues (eg, peripheral neuropathy, ulcers, cellulitis, Charcot foot, osteomyelitis, peripheral vascular disease, and minor or major amputation), and kidney problems (eg, acute kidney failure, chronic kidney disease, unspecified kidney failure, dialysis, and kidney transplant).

Findings

Results showed that during 177 851 person-years of follow-up, the overall incidence rates per 1000 person-years for CVD, eye, lower limb, and kidney complications were 37, 52, 21, and 32, respectively.

Investigators observed that men had a greater risk of CVD (adjusted hazard ratio [aHR] 1.51, 95% CI 1.43-1.59), lower limb (aHR 1.47, 95% CI 1.38-1.57), and kidney (aHR 1.55, 95% CI 1.47-1.64) complications than women. Men also had a higher risk of diabetic retinopathy (aHR 1.14, 95% CI 1.03-1.26), according to the results.

Over a 10-year period, a higher percentage of men experienced CVD (44%), eye (57%), lower limb (25%), and kidney (35%) complications compared to women (31%, 61%, 18%, and 25%, respectively).

Diabetes duration (<10 years vs ≥10 years) did not substantially affect the sex differences in complications, researchers noted, indicating a “need for targeted complication screening and prevention strategies from the time of diabetes diagnosis.”

“Further investigation into the underlying mechanisms for the observed sex differences in diabetes complications are needed to inform targeted interventions,” investigators concluded.

Reference: Gibson AA, Cox E, Schneuer FJ, et al. Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes. J Epidemiol Community Health. Published online May 16, 2024. doi:10.1136/jech-2023-221759