title: Sex-specific differences in metabolic control, cardiovascular risk, and interventions in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Sex-specific differences appear particularly relevant in the management of type 2 diabetes mellitus (T2DM), with women experiencing greater increases in cardiovascular morbidity and mortality than do men.
  
  
  OBJECTIVE
  The aim of this article was to investigate the influence of biological sex on clinical care and microvascular and macrovascular complications in patients with T2DM in a Central European university diabetes clinic.
  
  
  METHODS
  In a cross-sectional study, sex-specific disparities in metabolic control, cardiovascular risk factors, and diabetic complications, as well as concomitant medication use and adherence to treatment recommendations, were evaluated in 350 consecutive patients who were comparable for age, diabetes duration, and body mass index. Study inclusion criteria included age ≤75 years, T2DM, a documented history of presence or absence of coronary heart disease (CHD), and informed consent. Patients were followed in the diabetes outpatient clinic between November 2007 and March 2008.
  
  
  RESULTS
  Two hundred and one patients with T2DM met inclusion criteria (93 [46.3%] women, 108 [53.7%] men). Women with T2DM had higher mean (SE) systolic blood pressure (155.4 [22.5] vs 141.0 [19.8] mm Hg for men; P < 0.001) and total cholesterol (TC) (5.28 [1.34] vs 4.86 [1.29] mmol/L for men; P < 0.05), but a lower TC:HDL-C ratio (4.1 [1.19] vs 4.5 [1.2] for men; P < 0.05). Slightly more men (32.4%) than women (26.9%) reached the therapeutic goal of <7.0% for glycosylated hemoglobin. Women with shorter diabetes duration (<10 years) received oral antihyperglycemic therapy less frequently (P < 0.05). Women with longer disease duration had hypertension more frequently than did their male counterparts (100% vs 86.0%, respectively; P < 0.01). Despite a similar rate of CHD, men were twice as likely as women to have had coronary interventions (percutaneous transluminal coronary angioplasty/coronary artery bypass graft, 25.0% vs 12.9%, respectively; P < 0.05). Women with CHD also had a higher rate of cerebral ischemia than did men (27.6% vs 5.4%, respectively; P < 0.05) and received aspirin less frequently for secondary prevention (P < 0.001). Men had greater overall adherence to diabetes and cardiovascular risk guidelines than did women (66.4% vs 58.9%, respectively; P < 0.01).
  
  
  CONCLUSIONS
  In this study of diabetes clinic outpatients, women with T2DM had a worse cardiovascular risk profile and achieved therapeutic goals less frequently than did men. Treatment strategies should be improved in both sexes, but women with diabetes may be in need of more aggressive treatment, especially when cardiovascular disease is present.
authors.affiliation: Department of Internal Medicine III, Medical University of Vienna, Austria. alexandra.kautzky-willer@meduniwien.ac.at
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
authors.forename: Majid Reza
authors.initials: MR
authors.lastname: Kamyar
authors.forename: Dora
authors.initials: D
authors.lastname: Gerhat
authors.forename: Ammon
authors.initials: A
authors.lastname: Handisurya
authors.forename: Gunar
authors.initials: G
authors.lastname: Stemer
authors.forename: Stephen
authors.initials: S
authors.lastname: Hudson
authors.forename: Anton
authors.initials: A
authors.lastname: Luger
authors.forename: Rosa
authors.initials: R
authors.lastname: Lemmens-Gruber
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D010349:Patient Compliance; D011322:Primary Prevention; D055502:Secondary Prevention; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents; D001241:Aspirin; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008055:Lipids; C517652:hemoglobin A1c protein, human