Gender-Based Differences and Menstrual Cycle-Related Changes in Specific Diseases:Implications for Pharmacotherapy

, From the Faculty of Pharmaceutical Sciences, University of British Columbia, and the Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada.

Pharmacotherapy. 2000;20(5) 

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Gender-Specific Differences in Diabetes

Diabetes is the seventh leading cause of death among Americans and accounts for $98 billion in direct medical costs and disability each year.[62] Approximately 16 million Americans have diabetes; approximately 55% of them are women.[62,63] More people with type 2 diabetes mellitus are women (58.4%) compared with men (41.6%), whereas about 47% with type 1 disease are women.[63,64] Among different studies, prevalence rates of diabetes are not consistently higher for women, with the ratio of the prevalence in women versus men varying among populations studied, probably due to different distributions of risk factors such as body mass index, physical activity, and genetic differences.[63,64]

Even with few gender differences in prevalence, complications of diabetes have a significant impact on women.[65] More than 169,000 people died from the disease in 1992.[62] Diabetes also is the leading cause of new cases of blindness, end-stage renal disease, and lower extremity amputations. It increases the risk of heart attack or stroke 2-4-fold, and these patients spend about 24 million days in the hospital annually.[62] Gestational diabetes, defined as glucose intolerance that is first diagnosed during pregnancy, affects 2-5% of all pregnancies in the United States.[65]

Some gender differences are seen in acute and chronic complications of the disease. Almost twice as many women were discharged with the diagnosis of nonketotic hyperosmolar coma than men, according to the United States National Hospital Discharge Survey of 1989-1991.[66] The number of women discharged with hypoglycemia was almost 1.5 times that of men.[66] In another population-based study, the rate of diabetic acidosis in females was 1.5 times that of males.[67] No notable gender differences exist with respect to chronic complications except for a significantly higher frequency of blindness in women than men aged 40-59 years (60.1 vs 35.9/100,000 person-years, p=0.022), 60-69 years (76.4 vs 41.0/100,000 person-years, p<0.001), 70-79 years (101.9 vs 32.1/100,000 person-years, p<0.001), and older than 80 years (81.2 vs 33.3/100,000 person-years, p=0.003).[68] Speculated reasons are that women have longer duration of diabetes, registration of blind men may be less complete, and diabetic men may be more likely than women to die before they develop severe retinopathy.[68]


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