In a recent study published in the Journal of Epidemiology and Community Health, researchers investigated gender disparities in microvascular and macrovascular complication rates among individuals with diabetes.

​​​​​​​Study: Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes. Image Credit: Halfpoint/Shutterstock.com

Diabetes is equally prevalent in women and men worldwide; however, there is contradictory information concerning gender disparities in diabetes-related comorbidities. Diabetes causes multiple microvascular and macrovascular complications, including vision loss, amputation, renal failure, myocardial infarction, and stroke.

Men with diabetes are more likely than women to get cardiovascular disease. However, there is minimal data to support sex differences in microvascular complications.

Longer duration of diabetes raises the risk of complications, but there is limited research on the effects of the period of diabetes on gender disparities in diabetes-associated complications.

In the present population-based prospective cohort study, researchers examined gender-sex-based differences in vascular complications among diabetics. They also examined whether the diabetes duration affected the disparities.

The researchers linked the 45 and Up Study performed in Australia to administrative medical information. The study sample included 25,713 diabetics (57% men) aged 45 and above.

Participants were selected from the Services Australia Medicare database from 2005 to 2009, excluding those with a history of diabetes-related complications or data discrepancies.

The key study exposures were gender and diabetes duration at the start. The team analyzed data provided by the participants in baseline questionnaires linked to medical service claims data [Medicare Benefits Schedule (MBS)], hospitalization [Admitted Patient Data Collection (APDC)], drug prescriptions [Pharmaceutical Benefits Scheme (PBS)], and mortality registry information collection (Births, Deaths, and Marriages Registry).

Using hospitalization data and health-care claim records, the researchers identified new-onset cardiovascular disease (CVD) and lower limb, renal, and eye complications.

They employed diagnostic codes from the International Classification of Diseases and Related Health Complications (ICD-10-AM) and the Australian Classification of Healthcare Interventions (ACHI).

The researchers generated the adjusted hazard ratios (aHR) for the analysis using multivariate Cox proportional hazards regression modeling. The study's variables included sociodemographic, health, and lifestyle aspects.

The sociodemographic characteristics measured were age, socioeconomic status (IRSD), income, educational attainment, spoken languages, private medical insurance, and nationality.

Body mass index (BMI), physical activity, vegetable and fruit consumption, smoking status, and family history of diabetes were all considered lifestyle and health factors.

Cardiovascular complications included transient ischemic attacks (TIA), ischemic heart disease, heart failure, a stroke, and cardiomyopathy. Eye issues included cataracts and diabetic retinopathy.

Diabetic complications affecting the lower limb included ulcers, peripheral neuropathy, Charcot foot, cellulitis, peripheral vascular diseases, osteomyelitis, and amputations. Kidney difficulties included acute renal failure, chronic renal illness, dialysis, and renal transplantation.

The age-adjusted incidence rates per 1,000 individual years for eye, heart, kidney, and lower limb complications were 52, 37, 32, and 21, respectively.

Males were more likely than females to have cardiovascular issues (aHR, 1.5), lower limb complications (aHR, 1.5), and renal difficulties (aHR, 1.6), as well as eye-related diabetes complications (aHR, 1.1).

Over ten years, 57%, 44%, 35%, and 25% of men had retinal, cardiovascular, renal, and lower limb issues, compared to 61%, 31%, 25%, and 18% of females. Diabetes duration (less than ten years vs. ten years or more) did not significantly affect sex-based variations in diabetes complications.

Males had a higher rate of cardiovascular disease (CVD) complications per 1,000 individual years than females (43 versus 30).

Both genders experienced comparable eye complications, although males had a lower risk of cataract surgery (aHR, 0.9) but a higher risk of diabetic retinopathy (10 vs. 9 per 1,000 individual years; aHR, 1.1). After ten years, the cumulative incidence of ocular complications was 57% in males and 61% in females.

Males were 1.5 times more likely than females to experience any lower limb complication, as well as osteomyelitis and amputation.

Men had a higher cumulative incidence of lower limb complications at 10 years (25%) than women (18%). Men had a higher incidence rate of renal complications than women (36 vs. 26 per 1,000), and their risk was 1.6 times higher (aHR, 1.6).

The study reveals that male diabetics are more likely to develop complications such as cardiovascular disease, lower limb and renal difficulties, and diabetic retinopathy, regardless of how long they have had diabetes.

This underscores the importance of focused complication detection and prevention efforts. The study indicates that every 1,000 individual years, an average of 37, 52, 21, and 32 patients with diabetes experience difficulties.

Men are 1.5 times more likely to have CVD, lower-limb and renal complications, and diabetic retinopathy (14% higher risk). Women with diabetes are more likely to develop cataracts, which can cause ocular issues.

Further study, with larger sample sizes and adjustments for confounding factors such as lipid profiles, glycemic management, blood pressure control, and medicines, might increase knowledge of sex differences and underlying processes, allowing for more focused therapies.

Journal reference:

Gibson AA, Cox E, Schneuer FJ, et al. (2024) Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes. J Epidemiol Community Health 2024;0:1–8. doi: 10.1136/jech-2023-221759.