Women with type 2 diabetes treated with a structured personalized-care approach for 6 years have significantly better mortality outcomes than women who receive routine diabetes care, but the same was not the case for men, a new study indicates.
"We do not suggest that men should not be provided structured diabetes care," Marlene Krag, MD, from the University of Copenhagen, Copenhagen, Denmark, told Medscape Medical News in an email.
"But we need to develop gender-sensitive treatment schemes that can render to men the improvement in survival that we see in women."
The results were published online November 26 in Diabetologia.
Women receiving structured care experienced lower all-cause mortality and lower incidences of diabetes-related death, any diabetes-related end point, and stroke, compared with women in the control (routine-care) group. Such effects were not seen in men.
The structured personal-care intervention lowered HbA1c in women but not men, and this lowering of HbA1c could therefore contribute to explaining the positive outcome for women, say the authors. However, the difference in mortality outcome persisted after adjustment for HbA1c, and thus the results involve "complex social and cultural issues of gender," they stress.
Significant Differences With Structured vs Routine Care in Women
In the work, the researchers set out to to assess gender differences in mortality and morbidity during 13 post hoc follow-up years after 6 years of structured personal care in 1381 newly diagnosed type 2 diabetes patients treated in Diabetes Care in General Practice, a multicenter, cluster-randomized controlled trial.
The "structured personal-care" intervention included regular follow-up, individualized goal setting, and continuing medical education of general practitioners participating in the intervention.
In contrast, GPs in the routine-care group were free to choose any treatment they favored and to change it over time.
The post hoc observational analysis followed 970 patients for 13 years thereafter using national registries. Outcomes were all-cause mortality, incidence of diabetes-related death, any diabetes-related end point, myocardial infarction, stroke, peripheral vascular disease, and microvascular disease.
"During 13 years of follow-up, no statistically significant reductions in outcomes were observed for men when comparing the structured personal-intervention group with the routine-care group," Dr Krag and colleagues report.
In women, however, there was a 35% significantly lower risk for any diabetes-related end point after adjustment for age, diabetes duration, clustering, physical activity, smoking, and clinical variables.
There was also a 30% lower risk of diabetes-related death, a 26% lower risk of all-cause mortality, and a 41% lower risk of stroke in favor of the structured personal-care group compared with the routine-care group.
Event Rates and Hazard Ratios (HRs) for Outcomes in Women Randomized to Structured Personalized Care vs Routine Diabetes Care
| Outcome | Structured personalized care (events per 1000 patient-years) | Routine diabetes care (events per 1000 patient-years) | Hazard ratio | P |
| Any diabetes-related end point | 73.4 | 107.7 | 0.65 | .004 |
| Diabetes-related death | 34.6 | 45.7 | 0.70 | .031 |
| All-cause mortality | 55.5 | 68.5 | 0.74 | .028 |
| Stroke | 15.6 | 28.9 | 0.59 | .038 |
Gender Differences in Diabetes for Mortality Outcomes
Compared with routine care, structured personal diabetes care produce a differential effect between women and men for diabetes-related death (P for interaction = .015) and all-cause mortality (P for interaction = .005).
This gender difference was also observed for any diabetes-related outcome and stroke but was not statistically significant after extensive multivariate adjustment.
"From previous research we know that men and women tend to react differently to diabetes," Dr Krag noted.
Women tend to accept their diagnosis more readily than men and conform to treatment recommendations and related directions that optimize management of their disease, she added.
Men, in contrast, feel more challenged by diabetes and the demands it makes on their daily attention and the requirements it makes to adhere to lifestyle changes.
"Men are also less worried about the long-term consequences of disease and are more concerned with the influence of disease on their personal freedom," Dr Krag added.
"There is a need to rethink treatment schemes for both men and women to gain benefit from intensified treatment efforts."
The study was funded by the Danish Medical Research Council as well as a variety of Danish foundations, funds, associations, and ministries. Novo Nordisk also contributed to the research. The authors had no relevant financial relationships.
Diabetologia. Published online November 26, 2015. Abstract
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Cite this: Personalized Diabetes Care Better for Women With Type 2 Than Men - Medscape - Dec 01, 2015.
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