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Women With Type 2 Diabetes Face a Higher Burden of Risk Factors Compared to Men

Researchers have demonstrated that women, particularly younger women, with type 2 diabetes continue to experience a greater burden of cardiometabolic and socioeconomic risk factors than men with the disease. Type 2 diabetes triples the risk of death from cardiovascular disease in women, while it doubles the risk among men with type 2 diabetes. This disparity has been previously documented. However, a better understanding of the factors that contribute to worse outcomes among women is critical to optimize care strategies, effectively reduce risks, and fill treatment gaps for women with type 2 diabetes.

The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) was a randomized controlled trial comparing four blood glucose (sugar)-lowering medications (sulfonylurea, dipeptidyl peptidase 4 inhibitor, a glucagon-like receptor agonist, or insulin) on metabolic outcomes in adult men and women with type 2 diabetes who were already taking the drug metformin. While GRADE previously demonstrated that two diabetes drugs (liraglutide or insulin glargine) outperformed others when combined with metformin, the participant cohort continues to provide critical information to understand type 2 diabetes. In a secondary study, researchers sought to examine sex differences in adverse risk factors within the GRADE cohort, which included more than 5,000 individuals from diverse racial and ethnic backgrounds, with more than one-third being women. This analysis showed that, compared to men with similar blood glucose control and duration of type 2 diabetes, women with type 2 diabetes in the GRADE study were younger, yet had more adverse risk factors for cardiovascular disease such as higher body mass index (a measure of weight relative to height), greater prevalence of severe obesity, and higher overall cholesterol levels. Moreover, women were less likely than men to receive treatment for high cholesterol. When the researchers assessed non-traditional, socioeconomic risk factors, they found that women in this cohort were more likely than men to be divorced, separated, or widowed, and they had fewer years of education and lower incomes. In addition, women were more likely than men to take antidepressant medication.

While decades of research have documented that women with type 2 diabetes are less likely to receive evidence-based care for cardiometabolic risk factor management, the results from this study indicate that disparities continue to persist. In addition, these results demonstrate that substantial differences in adverse socioeconomic factors between women and men remain apparent. Taken together, there is a pressing need to optimize health care strategies to reduce health disparities and fill treatment gaps for women.

Gulanski BI, Butera NM, Krause-Steinrauf H,…Aroda VR; for the GRADE Research Group. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 11: e003159, 2023.
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