title: The Effect of Sex and Gender on Diabetic Complications.
abstract: While in non-diabetic people the risk for cardiovascular disease is higher in men, diabetes completely reverts this sex-gender difference conferring to women a greater burden of cardiovascular complications. Additionally, all risk factors associated with cardiovascular disease appear to be more active in diabetic females than in their male counterparts. The reasons of this different impact of diabetes between genders are not completely clear. The aim of this review is trying to clarify these issues in a sex and gender perspective. Both genetic and hormonal factors are at the basis of sex-gender differences in diabetes, even do not explain the totality of data. Possibly women arrive later and in worse conditions to the diagnosis of diabetes, receive both diagnostic and therapeutic supports in a lesser measure and, finally, reach therapeutic goals as recommended by guidelines in a lesser extent. Further aspects of sex-gender differences in diabetic complications are represented by a more frequent prevalence of drug side effects in women, as well as by increased resistance to the action of drugs used in prevention or in the therapy of cardiovascular diseases. As to microvascular complications, the issue of sex-gender differences is even more complex, with some important differences emerging in experimental models 'in vitro', as well as in human pathology 'in vivo'. The main problem, however, also in this case, is that it is difficult to differentiate how common pathogenetic mechanisms acting in diabetes may differently impact between genders. In conclusion what is evident is that diabetes represents a 'risk magnifier' for the damage of both micro and macrovessels differently in men and in women. This issue deserves, therefore, a more careful approach from people involved in both clinical aspects and research regarding diabetes and its complications, in a sex-gender oriented perspective.
authors.affiliation: Via Pietro Dazzi 1, 50141 Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Seghieri
authors.affiliation: Agenzia Regionale Sanita, Regione Toscana, Florence, and Centro Studi Salute di Genere, AUSL3, Pistoia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Policardo
authors.affiliation: Diabetes Unit, Ospedale S Jacopo, Pistoia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Anichini
authors.affiliation: Departiment of Biomedical Sciences, University of Sassari and Laboratory of Sex-Gender Medicine, INBB Osilo-Sassari, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Franconi
authors.affiliation: Departiment of Biomedical Sciences, University of Sassari and Laboratory of Sex-Gender Medicine, INBB Osilo-Sassari, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Campesi
authors.affiliation: UODiabetologia ASL 2, Olbia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Cherchi
authors.affiliation: UODiabetologia ASL 2, Olbia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tonolo
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D048909:Diabetes Complications / Q000453:epidemiology*; D006801:Humans; D012307:Risk Factors; D012727:Sex Characteristics
keywords: Diabetes; adverse drug reactions; diabetic
  nephropathy; diabetic macroangiopathy; diabetic neuropathy; diabetic retinopathy; sex-gender differences