Gender-Disparities in Adults with Type 1 Diabetes: More Than a Quality of Care Issue. A Cross-Sectional Observational Study from the AMD Annals Initiative.
We evaluated gender-differences in quality of type 1 diabetes (T1DM) care. Starting from electronic medical records of 300 centers, 5 process indicators, 3 favorable and 6 unfavorable intermediate outcomes, 6 treatment intensity/appropriateness measures and an overall quality score were measured. The likelihood of women vs. men (reference class) to be monitored, to reach outcomes, or to be treated has been investigated through multilevel logistic regression analyses; results are expressed as Odd Ratios (ORs) and 95% confidence intervals (95%CIs). The inter-center variability in the achievement of the unfavorable outcomes was also investigated. Overall, 28,802 subjects were analyzed (45.5% women). Women and men had similar age (44.5±16.0 vs. 45.0±17.0 years) and diabetes duration (18.3±13.0 vs. 18.8±13.0 years). No between-gender differences were found in process indicators. As for intermediate outcomes, women showed 33% higher likelihood of having HbA1c ≥8.0% (OR = 1.33; 95%CI: 1.25-1.43), 29% lower risk of blood pressure ≥140/90 mmHg (OR = 0.71; 95%CI: 0.65-0.77) and 27% lower risk of micro/macroalbuminuria (OR = 0.73; 95%CI: 0.65-0.81) than men, while BMI, LDL-c and GFR did not significantly differ; treatment intensity/appropriateness was not systematically different between genders; overall quality score was similar in men and women. Consistently across centers a larger proportion of women than men had HbA1c ≥8.0%, while a smaller proportion had BP ≥140/90 mmHg. No gender-disparities were found in process measures and improvements are required in both genders. The systematic worse metabolic control in women and worse blood pressure in men suggest that pathophysiologic differences rather than the care provided might explain these differences.
Department of Internal Medicine, Montecchio Hospital Local Health Authority of Reggio Emilia, Reggio Emilia, Italy.
Valeria
V
Manicardi
Department of clinical and experimental medicine, University of Messina, Messina, Italy.
Giuseppina
G
Russo
Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy.
Angela
A
Napoli
Department of Internal Medicine, Endocrinology and Metabolism, S. Maria della Misericordia Hospital, Perugia, Italy.
Elisabetta
E
Torlone
S.S.D. Diabetes Unit, AAS5, Pordenone, Italy.
Patrizia
P
Li Volsi
Diabetes and Metabolism Unit, ASL TO5, Chieri, Italy.
Carlo Bruno
CB
Giorda
UOS Integrating Primary and Specialist Care, A.O. ICP, Milano, Italy.
Nicoletta
N
Musacchio
CORESEARCH SRL-Center for Outcomes Research and clinical Epidemiology, Pescara, Italy.
Antonio
A
Nicolucci
Diabetes and Metabolism Unit, Sandro Pertini Hospital, Rome, Italy.
Concetta
C
Suraci
CORESEARCH SRL-Center for Outcomes Research and clinical Epidemiology, Pescara, Italy.
Giuseppe
G
Lucisano
CORESEARCH SRL-Center for Outcomes Research and clinical Epidemiology, Pescara, Italy.
Maria Chiara
MC
Rossi
D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
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