Women With Diabetes Receive Less Intensive Treatment for Cardiovascular Risk Factors Than Men

June 20, 2008

June 20, 2008 (San Francisco) — An analysis of patient records in the German DUTY (Diabetes mellitus needs unrestricted evaluation of patient data to yield treatment progress) study has shown that disparities in treatment may be responsible for poor control of cardiovascular risk factors and related increased risk for mortality in women with diabetes and cardiovascular disease.

Ionna Gouni-Berthold, MD, a professor of medicine in the Second Department of Internal Medicine at the University of Cologne in Cologne, Germany, presented results of the study here at ENDO 2008, the Endocrine Society 90th Annual Meeting.

"Over the last 25 years, cardiovascular mortality in diabetics decreased steadily among men, but it hasn't improved in women during that time," Dr. Gouni-Berthold told Medscape Diabetes & Endocrinology. "What is not explained is why this cardiovascular risk factor is more deleterious to women than men."

Dr. Gouni-Berthold and colleagues designed the current study to determine whether the disparity is a product of differences in the treatment women and men receive from diabetologists, internists, and general practitioners. The researchers obtained medical records for 44,893 patients (48.6% men) with type 2 diabetes who are included in the DUTY registry. They compiled measurements of cardiovascular risk factors and evaluated the medical treatments patients received from 2002 through 2003.

Of the patients included in the study, approximately 39% (8050 women, 9521 men) were identified as having cardiovascular disease (CVD). As indicated by the presence of HbA1c levels of 8% or more, women with CVD were 15% more likely than men to have poor control of blood glucose (adjusted odds ratio [AOR], 1.15; 95% confidence interval [CI], 1.06 – 1.25; P = .0009) and 19% more likely to have systolic blood pressure above 140 mm Hg (95% CI, 1.11 – 1.29; P < .0001). Despite poor control of these risk factors in women with diabetes and CVD, physicians continued to prescribe antihypertensive and antihyperglycemic agents at comparable rates for men and women.

Regardless of cardiovascular status, women were more likely than men to have low-density lipoprotein cholesterol (LDL-C) levels of 130 mg/dL or higher (AOR, 1.25; 95% CI, 1.18 – 1.32; P < .0001), and women with CVD were 44% more likely to have poor cholesterol control than men with CVD (AOR, 1.44; 95% CI, 1.33 – 1.55; P < .0001). Although LDL-C levels were poorly controlled in women with diabetes and CVD in the study, physicians were 15% less likely to prescribe lipid-lowering medications for women than for men with diabetes and CVD (AOR, 1.15; 95% CI, 0.79 – 0.91; P < .0001).

"What we found is that women with diabetes and cardiovascular disease are more likely than men to have poor control of all cardiovascular risk factors, and the differences are huge in cholesterol," Dr. Gouni-Berthold summarized. She also cited 2 American studies that suggest that similar disparities exist outside of the German healthcare system.

Glenn Cunningham, MD, moderator of the session and a professor of medicine and professor of molecular and cellular biology at Baylor College of Medicine in Houston, Texas, expressed surprise that physicians fail to control cardiovascular risk factors in some patients. "We've learned through these large clinical trials that tight glucose control may not be so critical in terms of CVD, but control of blood pressure and control of lipids are critical for controlling CVD," Dr. Cunningham explained.

Dr. Gouni-Berthold recommended improved education to remind physicians that these women are at risk. "I think from our study one can infer that this mysterious gender disparity in cardiovascular mortality between men and women could be reduced or even cancelled if women finally get equal treatment," she predicted.

Dr. Gouni-Berthold and Dr. Cunningham have disclosed no relevant financial relationships.

ENDO 2008: The Endocrine Society 90th Annual Meeting: Abstract P1-327. Presented June 15, 2008.

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