Abstract
BackgroundInsight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.MethodsPubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.ResultsOverall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.ConclusionOverall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.
Highlights
In 2019, an estimated 463 million adults aged between 20 and 79 years had diabetes, affecting 9.0% of women and 9.6% of men globally
Incidence rates of major Cardiovascular diseases (CVD) have been reported to be higher in men than women with and without diabetes [3, 4], there is a growing body of evidence showing that the relative risk of major cardiovascular complications conferred by diabetes is larger in women than men [2,3,4,5,6,7,8]
This systematic review including 81 studies showed that the presence, magnitude, and direction of sex disparities in the assessment of cardiovascular risk factors and screening of diabetes-related complications varied considerably across studies, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams
Summary
In 2019, an estimated 463 million adults aged between 20 and 79 years had diabetes, affecting 9.0% of women and 9.6% of men globally. Several large studies have shown that the relative risk of ischemic heart disease conferred by diabetes can be up to 50% higher in women than men [3, 5, 8]. A sex differential in the consequence of diabetes has been reported for stroke, where the relative risk of stroke was 27% higher among women than men [6]. A meta-analysis has demonstrated that diabetes confers a 19% higher relative risk of vascular dementia in women than men [9]. Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications
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