Failure to control conventional cardiovascular risk factors in women with type 2 diabetes might explain worse mortality

Stedman, Michael; Whyte, Martin B.; Laing, Ian; Fryer, Anthony A.; Torres, Bernardo Meza; Robinson, Adam; Mannan, Fahmida; Gibson, J. Martin; Rayman, Gerry; Heald, Adrian H.

Abstract

Introduction: The standardised mortality rate (SMR) for people with diabetes in England is 1.5–1.7, with differences in outcomes between sexes. There has been little work examining the factors that could have an impact on this or on what may determine sex differences in outcome. Methods: Data were extracted for patients with type 2 diabetes (T2D) in Salford (England) in 2010 for the years up to 2020, including any deaths recorded. Expected deaths were calculated from annual Office of National Statistics mortality rate and life expectancy by age and gender, adjusted for the local Index of Multiple Deprivation (IMD). This provided the SMR deprivation (SMRd), and life expectancy years lost per death (LEYLD). The effects of treatment type, and clinical features on SMRd relative to sex were examined by univariable and multivariable analysis. Results: Data from n = 11,806 (F = 5184; M = 6622) patients were included. Of these, n = 5540 were newly diagnosed and n = 3921 died (F = 1841; M = 2080). In total, n = 78,930 patient years. The expected deaths numbered n = 2596 (adjusted for age, sex, and IMD). Excess deaths were n = 1325 (F = 689; M = 636). Life expectancy years lost (LEYL) 18,989 (F = 9714; M = 9275). SMRd 1.51 (F = 1.60; M = 1.44) and LEYLD 4.84 years (F = 5.28; M = 4.46). The impact of risk factors was not different by sex. However, women had higher prevalence of % diagnosed >65 years of age; % last eGFR <60 mLs/min/1.73 m2, and lower prevalence of % prescribed ACE‐inhibitor/ARB, DPP4‐inhibitor and SGLT2‐inhibitor. Applying the male prevalence rate to the female population and expected mortality suggested n = 437 (55%) of excess T2D female deaths were attributed to sex difference in the prevalence of these risk and protective factors. Conclusions: Outcomes in women with T2DM are worse than in men, contributed to by greater prevalence of adverse factors and less prescribing of cardioprotective medication.

Citation

Stedman, M., Whyte, M. B., Laing, I., Fryer, A. A., Torres, B. M., Robinson, A., …Heald, A. H. (2023). Failure to control conventional cardiovascular risk factors in women with type 2 diabetes might explain worse mortality. Diabetes/Metabolism Research and Reviews, 39(8), Article e3695. https://doi.org/10.1002/dmrr.3695

• Journal Article Type: Article
• Acceptance Date: Jul 3, 2023
• Online Publication Date: Aug 17, 2023
• Publication Date: 2023-11
• Deposit Date: Aug 21, 2023
• Journal: Diabetes/Metabolism Research and Reviews
• Print ISSN: 1520-7552
• Electronic ISSN: 1520-7560
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: 8
• Article Number: e3695
• DOI: https://doi.org/10.1002/dmrr.3695
• Keywords: male, mortality, type 2 diabetes, cohort, risk factors, female