Abstract
BackgroundDiabetes is a stronger risk factor for cardiovascular complications in women than men.AimTo evaluate whether there are sex differences in cardiovascular risk management in patients with diabetes in primary care.Design & settingA cross-sectional study was undertaken using data from 12 512 individuals with diabetes within the Dutch Julius General Practitioners Network (JGPN) from 2013.MethodLinear and Poisson regression analyses were used to assess sex differences in risk factor levels, assessment, treatment, and control.ResultsNo sex differences were found in HbA1c levels and control, while small differences were found for cardiovascular risk management. Blood pressure levels were higher (mean difference [MD] 1.09 mmHg; 95% confidence intervals [CI] = 0.41 to 1.77), while cholesterol levels (MD -0.38 mmol/l; 95% CI = -0.42 to -0.34) and body mass index ([BMI] MD -1.79 kg/m2; 95% CI = -2.03 to 1.56) were lower in men than women. Risk factor assessment was similar between sexes, apart from high-density lipoprotein cholesterol (HDL-c), which was more commonly assessed in women (risk ratio [RR] 1.16; 95% CI = 1.13 to 1.20). Among those with a treatment indication for prevention, women with cardiovascular disease (CVD) were less likely to receive lipid-lowering drugs (RR 0.84; 95% CI = 0.76 to 0.93) than men, while women without CVD were more likely to receive lipid-lowering drugs (RR 1.16; 95% CI = 1.04 to 1.2). Among those treated, women were more likely to achieve systolic blood pressure (SBP) control (RR 1.06; 95% CI = 1.02 to 1.10) and less likely to achieve low-density lipoprotein cholesterol (LDL-c) control (RR 0.88; 95% CI = 0.85 to 0.91) than men.ConclusionIn this Dutch primary care setting, sex differences in risk factor assessment and treatment of people with diabetes were small. However, women with diabetes were less likely to achieve control for LDL-c and more likely to achieve blood pressure control than men with diabetes.
Highlights
Diabetes mellitus is one of the most prevalent chronic disorders globally, with an estimated prevalence of 425 million affected individuals in 2017.1 Individuals with diabetes are 2–3 times more likely to develop cardiovascular disease (CVD) compared with individuals without diabetes
No sex differences were found in HbA1c levels and control, while small differences were found for cardiovascular risk management
Risk factor assessment was similar between sexes, apart from high-density lipoprotein cholesterol (HDL-c), which was more commonly assessed in women
Summary
Diabetes mellitus is one of the most prevalent chronic disorders globally, with an estimated prevalence of 425 million affected individuals in 2017.1 Individuals with diabetes are 2–3 times more likely to develop CVD compared with individuals without diabetes. Previous studies have reported mixed findings regarding the presence, magnitude, and direction of sex differences in cardiovascular risk management for people with diabetes.[7,8,9,10,11,12] For example, the National Diabetes Audit in the UK demonstrated that women were less likely than men to receive annual tests for cardiovascular risk factors and to achieve treatment targets.[7] In contrast, a large cross-sectional study among 18 000 men and women with diabetes in the US showed that women with diabetes were more likely than men to receive annual dilated eye exams and blood pressure control tests, and to visit a doctor than men with diabetes. Design & setting: A cross-sectional study was undertaken using data from 12 512 individuals with diabetes within the Dutch Julius General Practitioners Network (JGPN) from 2013.
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