title: Gender differences in the progression of target organ damage in patients with increased insulin resistance: the LOD-DIABETES study.
abstract: BACKGROUND
  The purpose of this study was to analyze the evolution of vascular, cardiac and renal target organ damage (TOD) in patients with increased insulin resistance over a 3.5 year follow-up and to investigate gender difference and factors that influence its progression.
  
  
  METHODS
  We performed a prospective observational study involving 112 patients (71 men, 41 women) who were followed for 3.5 years. Measurements included blood pressure, blood glucose, lipids, smoking, body mass index (BMI) and HOMA-Ir Vascular TOD included carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI). Cardiac TOD included Cornell voltage-duration product and Sokolow. Renal TOD included creatinine, glomerular filtration and albumin/creatinine ratio.
  
  
  RESULTS
  The IMT increased in both genders. Each year, the IMT increased 0.005 mm in men and 0.011 in women and the PWV 0.024 and 0.020 m/sec, respectively. The highest increase was in women with type 2 diabetes mellitus, who had an increase in TOD carotid (40%), PWV (24%) and renal TOD (20 %). Multiple regression analysis, after adjusting for age and gender, showed a negative association between duration since diabetes diagnosis and ABI (β = -0.006; p = 0.017) and between BMI and glomerular filtration (β = -0.813; p = 0.014). HbA1c was positively associated with PWV (β = 0.501; p = 0.014).
  
  
  CONCLUSIONS
  This study showed that the progression of vascular and renal TOD differs by gender. The increase in vascular and renal TOD was higher in women, especially in diabetic women. The PWV increase showed a positive association with mean HbA1c levels during the follow-up. Glomerular filtration was associated with BMI and the ABI was associated with duration since type 2 diabetes mellitus diagnosis.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier NCT01065155.
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. magomez@usal.es.|Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. magomez@usal.es.|Medicine Department, University of Salamanca, Salamanca, Spain. magomez@usal.es.
authors.forename: Manuel Ángel
authors.initials: MÁ
authors.lastname: Gómez-Marcos
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. donrecio@gmail.com.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Recio-Rodríguez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. leticiagmzsnchz@gmail.com.
authors.forename: Leticia
authors.initials: L
authors.lastname: Gómez-Sánchez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. cagudoconde@yahoo.es.|Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. cagudoconde@yahoo.es.
authors.forename: Cristina
authors.initials: C
authors.lastname: Agudo-Conde
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. emilianorodriguezsanchez@yahoo.es.|Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. emilianorodriguezsanchez@yahoo.es.|Medicine Department, University of Salamanca, Salamanca, Spain. emilianorodriguezsanchez@yahoo.es.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Rodríguez-Sanchez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. jmaderuelo@saludcastillayleon.es.|Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. jmaderuelo@saludcastillayleon.es.
authors.forename: JoseAngel
authors.initials: J
authors.lastname: Maderuelo-Fernandez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. magoma@usal.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Gomez-Sanchez
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Avda. Comuneros 27, 37003, Salamanca, Spain. lgarciao@usal.es.|Castilla and León Health Service-SACYL. REDIAPP, IBSAL, Salamanca, Spain. lgarciao@usal.es.|Medicine Department, University of Salamanca, Salamanca, Spain. lgarciao@usal.es.
authors.forename: Luís
authors.initials: L
authors.lastname: García-Ortiz
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D059168:Carotid Intima-Media Thickness; D003404:Creatinine / Q000378:metabolism; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000378:metabolism; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000378:metabolism; D012709:Serum Albumin; D012737:Sex Factors; D014652:Vascular Diseases / Q000453:epidemiology
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; D012709:Serum Albumin; C517652:hemoglobin A1c protein, human