Type 1 diabetes appears to be more hazardous to women. Female patients had a 37% higher risk of dying early from any cause compared to their male counterparts, according to a new meta-analysis.
In addition, among patients with type 1 diabetes, the risk of developing coronary heart disease was 2.5 times higher in women compared to men. Women with type 1 diabetes were also more likely to experience stroke and to die of cardiovascular and kidney diseases.
Rachel Huxley, MD, professor of epidemiology at the University of Queensland in Australia, and colleagues speculate the excess vascular risks in women are due to “greater cumulative exposure to hyperglycemia because of poorer glycaemic control.” Girls with type 1 diabetes may experience less insulin sensitivity during puberty, more underdosing of insulin, and more eating disorders, they hypothesized.
Other possibilities include: earlier vascular calcification, endothelial dysfunction, lipid changes, abdominal fat and/or disturbances in the hypothalamus-pituitary-ovarian axis.
In an accompanying editorial, David Simmons, DMED, professor of medicine at the University of Western Sydney in Australia, mentioned that tight glucose control probably isn’t the entire solution. At best, it limits complications, but cardiovascular disease (CVD) benefits do not accrue for almost 20 years of tight control.
“A key question is how the risk of excess mortality in women can be reduced further,” Dr. Simmons stated. For example, he asked, should statins or ACE inhibitors be started at mild elevations of hemoglobin A1C, or blood pressure treated to lower levels in young women? What’s clear is further investigation and appropriate action are required.
For the meta-analysis, published in The Lancet Diabetes & Endocrinology, the researchers reviewed 26 studies including more than 200,000 individuals. Compared to men with type 1 diabetes, women with the condition had an 86%, 44%, and 37% higher risk of fatal CVD, fatal kidney disease, and stroke, respectively. No sex differences were found for cancer, accident, or suicide.
Dr. Simmons argues that health funding for type 1 diabetes should not be sex-based, but for the benefit of all patients.
- Huxley, R, et al. Published online by The Lancet Diabetes; doi: 10.1016/S2213-8587(14)70248-7.
- Simmons, David. Editorial published online by The Lancet Diabetes; doi: 10.1016/S2213-8587(14)70272-4.