Disparity in management of diabetes and coronary heart disease risk factors by sex in DCCT/EDIC.
OBJECTIVE
Coronary heart disease (CHD) is a major cause of morbidity and mortality in patients with diabetes. Sex disparity in the treatment of modifiable CHD risk factors in patients with Type 2 diabetes has been reported previously; however, there is little comparable information in Type 1 diabetes.


METHODS
We performed a cross-sectional analysis of 1153 subjects with Type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort to compare achievement of metabolic and CHD risk factor goals and use of recommended risk factor interventions between the sexes.


RESULTS
Women were less likely than men to achieve glycated haemoglobin (HbA1c)<7.0% [adjusted odds ratio (AOR) 0.76, 95% confidence interval (CI) 0.57-0.995] or<8.0% (AOR 0.74, 95% CI 0.58-0.95). Achievement of target lipid levels was not significantly different between the sexes. As in the non-diabetic population, men had higher blood pressure. Women were significantly less likely than men to report using aspirin (AOR 0.77, 0.60-0.99) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (AOR 0.62, 0.49-0.80) and statins (AOR 0.56, 0.43-0.73), even after adjusting for blood pressure and lipid levels, respectively. Reported use of statins was also lower in women than men in the subset that developed a low-density lipoprotein (LDL) cholesterol level>3.4 mmol/l (39% vs. 60%, P<0.05).


CONCLUSIONS
In Type 1 diabetes, women report lower frequency than men in the use of interventions that decrease CHD risk. These findings are consistent with reports in the Type 2 diabetic population, showing that risk-reducing measures are underused in women with diabetes.
Massachusetts General Hospital Diabetes Center, Boston, MA 02114, USA. mlarkin1@partners.org
M E
ME
Larkin
J-Y
JY
Backlund
P
P
Cleary
M
M
Bayless
B
B
Schaefer
J
J
Canady
D M
DM
Nathan
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005783:Gender Identity; D006442:Glycated Hemoglobin / Q000378:metabolism; D054625:Healthcare Disparities; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors
D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D008055:Lipids