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10-01-2019 | Older adults | Highlight | News

Type 2 diabetes sex disparities persist into very old age

medwireNews: Known sex differences among younger patients with type 2 diabetes persist among those aged 90 years and older, particularly optimal use of cardiovascular preventive therapies which is significantly less likely among women than men, Spanish research shows.

Miguel Angel Salinero-Fort (Consejería de Sanidad, Madrid) and co-investigators say their findings suggest that “[t]here is considerable room for improvement in standards of preventive care in nonagenarians with [type 2 diabetes], especially in females.”

The cross-sectional population-based study included 11,645 people aged 90 years and older (mean 92.9 years, 73% women) with type 2 diabetes who were living in Madrid on 31 December 2015.

The researchers report in BMJ Open that, compared with women, men had a significantly higher prevalence of coronary artery disease (21.5 vs 12.6%) and peripheral artery disease (8.5 vs 2.3%), but the rate of cerebrovascular disease was similar between the two sexes (16.5 vs 16.0%).

By contrast, women had a significantly higher prevalence of cardiovascular risk factors such as hypertension (84.7 vs 72.6%), dyslipidemia (49.5 vs 41.2%), and obesity (25.8 vs 16.8%), and were more likely to have impaired kidney function (52.1 vs 40.2%).

In spite of this, men were significantly more likely than women to be using antiplatelet therapy (48.1 vs 44.3%), statins (43.2 vs 40.2%), anticoagulants (23.4 vs 21.2%), and beta-blockers (21.4 vs 19.3%)/

There was no difference between men and women in the proportion achieving the glycated hemoglobin (HbA1c) target of below 7.0%, at 63.6% versus 64.7%, respectively.

But men were significantly more likely than women to achieve a target low-density lipoprotein (LDL) cholesterol level below 100 mg/dL (68.9 vs 55.6%), and were significantly more likely to receive optimal lipid-lowering therapy, ie, statins prescribed for overt cardiovascular disease (54.3 vs 36.4%)

Similarly, more men than women achieved the blood pressure target of less than 140/85 mmHg (67.4 vs 62.7%), while optimal use of antihypertensive therapy, defined as the treatment of known hypertensive patients with albuminuria with ACE inhibitors or angiotensin II receptor blockers, was also significantly more likely in men than in women (50.4 vs 39.1%).

Salinero-Fort et al conclude that at 90 years of age life expectancy “is only a few years and is almost equal in men and women […] with lower gender differences in mortality rates for coronary heart diseases after 75 years.”

They suggest that it is therefore “reasonable to think that at 90 years or over, there would be fewer gender differences in cardiovascular risk and physician-prescribed preventive treatments than at previous ages.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

BMJ Open 2019; doi:10.1136/bmjopen-2019-030344

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