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Sex-specific differences in long-term glycemic control and cardiometabolic parameters in patients with type 1 diabetes treated at a tertiary care centre

Gender aspects in type 1 diabetes

Geschlechtsspezifische Unterschiede von Blutzuckereinstellung und kardiometabolischen Risikofaktoren bei Patienten mit Typ 1 Diabetes im Langzeitverlauf – Gender Aspekte bei Typ 1 Diabetes

Geschlechtsspezifische Unterschiede bei Typ 1 Diabetes

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Summary

Background

Time-dependent changes in glycemic control might represent a strong predictor for coronary artery disease. Since a higher benefit from outpatient appointments has been discussed for female gender, the aim of the study was to assess gender differences in HbA1c levels and metabolic parameters at baseline as well as over 3 years of follow-up.

Methods

We analyzed the data of 54 female and 65 male type 1 diabetic patients, with comparable age and diabetes duration, who visited our diabetes outpatient clinic in the year 2006 as well as the follow-up visits until 2009.

Results

In 2006, females showed higher HbA1c levels as compared to male subjects (8.59 ± 1.60 vs. 7.75 ± 1.41, p = 0.003). Longitudinal analysis revealed that the decrease in HbA1c until 2009 was more pronounced in women (decreased to 7.52 ± 1.00) than in men (decreased to 7.50 ± 0.99, p sex:time = 0.006); however, the significance was lost after adjusting for baseline levels. Further, females showed higher levels in total-cholesterol (p = 0.001), LDL-cholesterol (p = 0.033), and HDL-cholesterol (p < 0.001) at baseline, whereas males had higher creatinine (p = 0.001) and uric acid levels (p < 0.001). No differences between the two sexes were shown for triglycerides at 2006. Additionally, uric acid levels were negatively associated with long term glycemic control, particularly in male patients.

Conclusions

Sex-related differences in metabolic parameters are present in patients with type 1 diabetes. Especially, our data suggests more adverse cardiometabolic risk markers in females. A potentially protective effect for hyperuricemia by hyperglycemia-related glucosuria is lacking in female patients with type 1 diabetes.

Zusammenfassung

Grundlagen

Zeitliche Veränderungen im glukometabolischen Profil gelten als wesentlicher prognostischer Parameter für die spätere Entwicklung kardiovaskulärer Komplikationen bei Patienten mit Typ 1 Diabetes. Ein größerer Nutzen regelmäßiger Ambulanzbesuche bei erkrankten Frauen wurde in früheren Studien diskutiert. Daher war es Ziel dieser Arbeit, geschlechtsspezifische Unterschiede von HbA1c sowie metabolischer Parameter im Verlauf von 3 Jahren zu untersuchen.

Methodik

54 Frauen und 65 Männer mit Typ 1 Diabetes (vergleichbar in Alter und Erkrankungsdauer) mit Besuchen an der Diabetesambulanz der Medizinischen Universität Wien zwischen den Jahren 2006 und 2009 wurden in diese retrospektive Untersuchung eingeschlossen.

Ergebnisse

Im Vergleich zu männlichen Patienten zeigten Frauen im Jahr 2006 höhere HbA1c Werte (8,59 ± 1,60 vs. 7,75 ± 1,41, p = 0,003). Eine Analyse des zeitlichen Trends zeigte eine deutlichere Verbesserung der Blutzuckereinstellung auf Seiten der Frauen (HbA1c Wert verringerte sich auf 7,52 ± 1,00 bei Frauen und auf 7,50 ± 0,99 bei Männern, p Geschlecht:Zeitverlauf = 0,006). Allerdings verlor sich die signifikante Interaktion nach Adjustierung für die Ausgangswerte. Weiters zeigten Frauen im Jahr 2006 höhere Werte im Gesamtcholesterin (p = 0,001), LDL-Cholesterin (p = 0,033) sowie HDL-Cholesterin (p < 0,001), wogegen höhere Serum-Kreatinin (p = 0,001) und Harnsäure Werte (p < 0,001) bei den männlichen Patienten beobachtet wurden. Keine signifikanten Unterschiede zeigten sich dagegen bei Triglyzeriden. Weiters wurde ein negativer Zusammenhang zwischen Harnsäure und HbA1c insbesondere bei männlichen Patienten beobachtet.

Schlussfolgerungen

Diese Studie zeigt geschlechtsspezifische Unterschiede in metabolischen Parametern bei Patienten mit Typ 1 Diabetes. Insbesondere zeigen Frauen ein deutlich ungünstigeres kardiometabolisches Risikoprofil. Der negative Zusammenhang zwischen Harnsäure und HbA1c zeigt sich bei Frauen weniger stark ausgeprägt.

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Conflict of interest

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Christian S. Göbl MD PhD, Latife Bozkurt MD, Johannes Lueck, Mona El-Samahi, Martin Clodi MD, Anton Luger MD & Alexandra Kautzky-Willer MD

  2. Department of Gynecology and Obstetrics, Division of Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria

    Christian S. Göbl MD PhD & Alexandra Kautzky-Willer MD

  3. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria

    Peter Grösser MSc

Authors
  1. Christian S. Göbl MD PhD
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  2. Latife Bozkurt MD
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Göbl, C., Bozkurt, L., Lueck, J. et al. Sex-specific differences in long-term glycemic control and cardiometabolic parameters in patients with type 1 diabetes treated at a tertiary care centre. Wien Klin Wochenschr 124, 742–749 (2012). https://doi.org/10.1007/s00508-012-0246-6

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