Abstract
BackgroundWomen with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures.MethodsIn a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders.ResultsMen with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation.ConclusionsOur findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.
Highlights
Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is the case for microvascular complications and retinal microvascular measures
No sex differences have been observed for chronic kidney disease [4], but in the same meta-analysis the excess risk for end stage renal disease associated with diabetes was higher in women than in men [4]
The main finding of this study is that there was no consistent pattern of sex differences in the associations of glucose metabolism status and glycemia with microvascular complications or retinal microvascular measures (i.e. no consistent sex-by-diabetes or sex-by-glycemia interaction)
Summary
Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is the case for microvascular complications and retinal microvascular measures. Type 2 diabetes is associated with an increased risk of both macro- and microvascular diseases [1]. Several studies have shown that type 2 diabetes is a stronger risk factor for macrovascular complications in women than in men [2]. An excess increased risk of microvascular complications associated with diabetes in women, compared with men, has been reported for vascular dementia [3]. No sex differences have been observed for chronic kidney disease [4], but in the same meta-analysis the excess risk for end stage renal disease associated with diabetes was higher in women than in men [4]. A prospective cohort study showed that only men with newly diagnosed diabetes and prediabetes had an increased risk of chronic kidney disease [5]. Most previous studies of diabetes-associated microvascular complications did not primarily focus on sex differences and were mostly restricted to one specific aspect of microvascular disease or to populations with type 2 diabetes only
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