Cardiovascular disease is a major cause of morbidity and mortality for women and men with diabetes. Previous cross-sectional studies of prevalent diabetes have found that women are less likely to meet American Diabetes Association (ADA) and American Heart Association guidelines for control of cardiovascular risk factors (hemoglobin A1c, low-density lipoprotein [LDL] cholesterol, and blood pressure), but have not studied the critical period immediately after diagnosis.
To assess gender differences in cardiovascular risk factors at the time of diabetes diagnosis (baseline) and 1 year later (follow-up), we conducted a retrospective cohort study of 6,547 individuals with incident diabetes in an integrated care delivery system. We assessed mean cardiovascular risk factor values by gender and adjusted odds ratios of attaining ADA goals.
Compared with men, at baseline women had lower hemoglobin A1c (7.9% vs. 8.2%; p < .001), higher LDL cholesterol (118.9 vs. 111.5 mg/dL; p < .001), higher systolic blood pressure (131.9 vs. 130.5 mmHg; p < .001), and lower diastolic blood pressure (79.1 vs. 79.7 mmHg; p = .006). At follow-up, the hemoglobin A1c gender gap had closed (6.9% vs. 6.9%; p = .39), and the gender gaps had decreased for blood pressure (129.8/77.0 vs. 128.9/77.6; p = .009) and LDL cholesterol (104.0 vs. 98.2 mg/dL; p < .001). These associations varied by age. Adjusted odds ratios showed similar relationships.
In this cohort of individuals with incident diabetes, men and women had important differences in risk factor control at the time of diabetes diagnosis. These differences varied by age and decreased over time.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Women's Health Issues
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Health system factors and antihypertensive adherence in a racially and ethnically diverse cohort of new users.JAMA Internal Medicine. 2013; 173: 54-61
- Standards of medical care in diabetes–2012.Diabetes Care. 2012; 35: S11-S63
- Standards of medical care in diabetes–2013.Diabetes Care. 2013; 36: S11-S66
- The effect of incident cancer, depression and pulmonary disease exacerbations on type 2 diabetes control.Journal of General Internal Medicine. 2011; 26: 575-581
- Suboptimal control of glycemia, blood pressure, and LDL cholesterol in overweight adults with diabetes: the Look AHEAD Study.Journal of Diabetes and Its Complications. 2008; 22: 1-9
- Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans?.Womens Health Issues. 2007; 17: 131-138
Casagrande, S. S., Fradkin, J. E., Saydah, S. H., Rust, K. F., & Cowie, C. C. (2013). The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care, 36, 2271–2279.
- Gender and racial disparities in the management of diabetes mellitus among Medicare patients.Womens Health Issues. 2007; 17: 150-161
- Good research practices for comparative effectiveness research: approaches to mitigate bias and confounding in the design of nonrandomized studies of treatment effects using secondary data sources: The International Society for Pharmacoeconomics and Outcomes Research Good Research Practices for Retrospective Database Analysis Task Force Report–Part II.Value in Health. 2009; 12: 1053-1061
- Age-dependent gender differences in hypertension management.Journal of Hypertension. 2011; 29: 1005-1011
- A new method for estimating race/ethnicity and associated disparities where administrative records lack self-reported race/ethnicity.Health Services Research. 2008; 43: 1722-1736
- Sex disparities in control and treatment of modifiable cardiovascular disease risk factors among patients with diabetes: Translating Research Into Action for Diabetes (TRIAD) Study.Diabetes Care. 2008; 31: 69-74
- Mortality trends in men and women with diabetes, 1971 to 2000.Annals of Internal Medicine. 2007; 147: 149-155
- 10-year follow-up of intensive glucose control in type 2 diabetes.New England Journal of Medicine. 2008; 359: 1577-1589
- Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.American Journal of Public Health. 1992; 82: 703-710
- Disparity in management of diabetes and coronary heart disease risk factors by sex in DCCT/EDIC.Diabetic Medicine. 2010; 27: 451-458
- Glycemic control in type 2 diabetes: time for an evidence-based about-face?.Annals of Internal Medicine. 2009; 150: 803-808
- Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: A guideline from the American Heart Association.Circulation. 2011; 123: 1243-1262
- A comprehensive view of sex-specific issues related to cardiovascular disease.CMAJ. 2007; 176: S1-44
- Management of hypertension in the elderly.Nature Reviews Cardiology. 2012; 9: 286-296
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Medical Care. 2005; 43: 1130-1139
- Comparing methods of measuring treatment intensification in hypertension care.Circulation Cardiovascular Quality Outcomes. 2009; 2: 385-391
- Simultaneous control of diabetes, hypertension, and hyperlipidemia in two health systems.Circulation Cardiovascular Quality Outcomes. 2012; 5: 645-653
- Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: A position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association.Journal of the American College of Cardiology. 2009; 53: 298-304
- Adjusting for treatment effects in studies of quantitative traits: Antihypertensive therapy and systolic blood pressure.Statistics in Medicine. 2005; 24: 2911-2935
- Are there gender differences in diabetes care among elderly Medicare enrolled veterans?.Journal of General Internal Medicine. 2006; 21: S47-S53
- Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants.New England Journal of Medicine. 1999; 341: 217-225
- Sex differences in mortality after acute myocardial infarction: changes from 1994 to 2006.Archives of Internal Medicine. 2009; 169: 1767-1774
- Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes.Diabetes Care. 2005; 28: 514-520
- Sex and racial/ethnic differences in cardiovascular disease risk factor treatment and control among individuals with diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA).Diabetes Care. 2009; 32: 1467-1469
- Developing and validating a diabetes database in a large health system.Diabetes Research and Clinical Practice. 2007; 75: 313-319
Emily B. Schroeder, MD, PhD, is an epidemiologist and endocrinologist at Kaiser Permanente Colorado Institute for Health Research and an Assistant Professor in the Department of Medicine at the University of Colorado. Her research focuses on diabetes and its complications.
Elizabeth A. Bayliss, MD, MSPH, is the Director for Scientific Development at the Kaiser Permanente Colorado Institute for Health Research and an Associate Professor in the Department of Family Medicine at the University of Colorado. Her research focuses on persons with multiple chronic medical conditions.
Stacie L. Daugherty, MD, MSPH, is cardiologist and Assistant Professor of Medicine in the Department of Medicine at the University of Colorado. Her research focuses on gender differences in hypertension management and cardiovascular procedures.
John F. Steiner, MD, MPH, is the Senior Director of the Kaiser Permanente Colorado Institute for Health Research and a Professor in the Department of Medicine at the University of Colorado. His research focuses on health disparities, prevention of cardiovascular disease, and medication adherence.
Accepted: September 26, 2013
Received in revised form: September 24, 2013
Received: June 4, 2013
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.