Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study
de Ritter, Rianneke; Sep, Simone J.S.; van der Kallen, Carla J.H.; van Greevenbroek, Marleen M.J.; de Jong, Marit; Vos, Rimke C.; Bots, Michiel L.; Reulen, Jos P.H.; Houben, Alfons J.H.M.; Webers, Carroll A.B.; Berendschot, Tos T.J.M.; Dagnelie, Pieter C.; Eussen, Simone J.P.M.; Schram, Miranda T.; Koster, Annemarie; Peters, Sanne A.E.; Stehouwer, Coen D.A.
(2021) Cardiovascular Diabetology, volume 20, issue 1, pp. 1 - 15
(Article)
Abstract
Background: Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods: In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)),
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we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results: Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions: Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.
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Keywords: Adult, Aged, Biomarkers/blood, Blood Glucose/metabolism, Cross-Sectional Studies, Diabetes Mellitus, Type 2/blood, Diabetic Angiopathies/blood, Diabetic Nephropathies/blood, Diabetic Neuropathies/blood, Diabetic Retinopathy/blood, Female, Health Status Disparities, Humans, Male, Microcirculation, Middle Aged, Netherlands/epidemiology, Prediabetic State/blood, Prevalence, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Sex Factors, Type 2 diabetes, Retinopathy, Sex, Neuropathy, Microvascular complications, Epidemiology, Women, Sex difference, Nephropathy, Research Support, Non-U.S. Gov't, Observational Study, Journal Article, Comparative Study
ISSN: 1475-2840
Publisher: BioMed Central
Note: Funding Information: This study was supported by ZonMw (Project No. 849200001), the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (Grant 31O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), CARIM, School for Cardiovascular Diseases (Maastricht, the Netherlands), School CAPHRI, Care and Public Health Research Institute (Maastricht, the Netherlands), NUTRIM, School of Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands) and by unrestricted grants from Janssen-Cilag B.V. (Tilburg, the Netherlands), Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands) and Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands). Publisher Copyright: © 2021, The Author(s).
(Peer reviewed)
