Abstract
This study aimed to test whether early-onset (defined as <40 years of age) type 2 diabetes mellitus (T2DM) imparted different risks of microvascular disease to Chinese men and women. 222,537 Chinese patients with T2DM were recruited in 630 hospitals from 106 cities in 30 provinces of China in 2012 using a cross-sectional design. Logistic regression analysis was performed to obtain odds ratios (ORs) of male vs. female for diabetic retinopathy (DR) and diabetic nephropathy (DN). Additive interaction was used to test whether male gender and early-onset T2DM had interactive effects for DR and DN. More men than women with T2DM had DN (4.5 vs. 3.0%, P < 0.0001), DR (5.3 vs. 5.1%, P < 0.0001), and microvascular disease (either DN or DR) (8.4 vs. 7.1%, P < 0.0001). After adjustment for age and levels of hospitals, the effect sizes of early-onset T2DM for microvascular disease were higher in men than in women, with a 2.67 [95% confidence intervals (CI): 2.51-2.85] fold risk in men and a 2.53 (95% CI: 2.35-2.72) fold risk in women. The risk effect sizes were greatly attenuated by further adjusting for diabetes durations and other traditional risk factors, with a 1.28 (95% CI: 1.19-1.37) fold risk in men and a 1.07 (95% CI: 0.99-1.16) fold risk in women. After adjustment for diabetes durations and other traditional risk factors, using women with late-onset T2DM as the reference, co-presence of early-onset and male gender significantly enhanced the ORs of either early-onset alone (1.10, 95% CI: 1.03-1.19) or male gender alone (0.96, 95% CI: 0.93-0.99) to 1.32 (95% CI: 1.24-1.41), with significant additive interaction. Kaplan-Meier analysis showed that in early-onset T2DM, DN developed 5 years earlier in men than in women. Early-onset T2DM increased more risk of microvascular complications in Chinese men than in women, most of increased risks being attributable to longer diabetes durations.
Highlights
The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, but its onset age is decreasing [1, 2]
A community-based cross-sectional study showed that female patients with T2DM had a higher prevalence of proteinuria and renal impairment than males with an increasing prevalence by age [25]
In the United Kingdom Prospective Diabetes Study, diabetic retinopathy (DR) was more prevalent in men than in women, and this could not be explained by the major risk factors, since women had higher blood pressure (BP) and higher glucose levels than men [26]
Summary
The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, but its onset age is decreasing [1, 2]. Our group reported that early-onset T2DM is at much increased risk of non-fatal cardiovascular disease (CVD) in China [10] but its effect size on microvascular disease in China remained largely uncertain. The prevalence and incidence of diabetes are rather similar in the two sexes [4], gender-specific effects of diabetes on microvascular and macrovascular disease are likely. Female gender at reproductive age is a protective factor from coronary heart disease (CHD) in the non-diabetic population [11]. This study aimed to test whether early-onset (defined as
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