title: Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative.
abstract: OBJECTIVE
  To investigate the quality of type 2 diabetes care according to sex.
  
  
  METHODS
  Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated.
  
  
  RESULTS
  Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c>9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10-1.17]), 42% more likely to have LDL cholesterol (LDL-C)≥130 mg/dL (1.42 [1.38-1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI≥30 kg/m2 (1.50 [1.50-1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure.
  
  
  CONCLUSIONS
  Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.
authors.affiliation: Corresponding author: Maria Chiara Rossi, mrossi@negrisud.it.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Rossi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Cristofaro
authors.forename: Sandro
authors.initials: S
authors.lastname: Gentile
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Valeria
authors.initials: V
authors.lastname: Manicardi
authors.forename: Maria Franca
authors.initials: MF
authors.lastname: Mulas
authors.forename: Angela
authors.initials: A
authors.lastname: Napoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Concetta
authors.initials: C
authors.lastname: Suraci
authors.forename: Carlo
authors.initials: C
authors.lastname: Giorda
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides