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Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program

Lim LL 1 , Lau ESH 2 , Kong APS 2 , Fu AWC 3 , Lau V 3 , Jia W 4 Show all authors , Sheu WHH 5 , Sobrepena L 6 , Yoon KH 7 , Tan ATB 8 , Chia YC 9 , Sosale A 10 , Saboo BD 11 , Kesavadev J 12 , Goh SY 13 , Nguyen TK 14 , Thewjitcharoen Y 15 , Suwita R 16 , Ma RCW 2 , Chow EYK 2 , Luk AOY 2 , Chan JCN 2

Affiliations 

  • 1 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 2 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
  • 3 Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, China
  • 4 Department of Endocrinology and Metabolism, Shanghai Clinical Centre for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
  • 5 Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • 6 Heart of Jesus Hospital, San Jose City, Philippines
  • 7 Department of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  • 8 Sunway Medical Centre, Selangor, Malaysia
  • 9 Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
  • 10 Diacon Hospital, Bangalore, India
  • 11 Dia Care - Diabetes Care & Hormone Clinic, Gujarat, India
  • 12 Jothydev's Diabetes and Research Center, Kerala, India
  • 13 Department of Endocrinology, Singapore General Hospital, Singapore
  • 14 MEDIC Medical Centre, Ho Chi Minh City, Vietnam
  • 15 Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
  • 16 Cerebrocardiovascular Diabetes Group Clinic (CDG), Jakarta, Indonesia
Lancet Reg Health West Pac, 2023 Mar;32:100663.
PMID: 36785858 DOI: 10.1016/j.lanwpc.2022.100663

Abstract

BACKGROUND: In Asia, diabetes-associated death due to cardiorenal diseases were 2-3 times higher in women than men which might be due to gender disparity in quality of care and health habits.

METHODS: Adults with type 2 diabetes (T2D) from 11 Asian countries/areas were assessed using the same protocol (2007-2015). We compared treatment target attainment (HbA1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-based LDL-cholesterol, lack of central obesity [waist circumference <90 cm in men or <80 cm in women), use of cardiorenal-protective drugs (renin-angiotensin system [RAS] inhibitors, statins), and self-reported health habits including self-monitoring blood glucose (SMBG) by gender. Analyses were stratified by countries/areas, age of natural menopause (<50 vs. ≥50 years), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney impairment [eGFR < 60 mL/min/1.73 m2]).

FINDINGS: Among 106,376 patients (53.2% men; median (interquartile range) diabetes duration: 6.0 (2.0-12.0) years; mean ± SD HbA1c 8.0 ± 1.9%; 27% insulin-treated), women were older and less likely to receive college education than men (28.9% vs. 48.8%). Women were less likely to smoke/drink alcohol and were physically less active than men. Women had lower BP (<130/80 mmHg: 29.4% vs. 25.7%), less general obesity (54.8% vs. 57.8%) but more central obesity than men (77.5% vs. 57.3%). Women were less likely to have ASCVD (12.8% vs. 17.0%) or heart failure (1.3% vs. 2.3%), but more likely to have kidney impairment (22.3% vs. 17.6%) and any-site cancer than men (2.5% vs. 1.6%). In most countries/areas, more men attained HbA1c <7% and risk-based LDL-cholesterol level than women. After adjusting for potential confounders including countries and centres, men had 1.63 odds ratio (95% CI 1.51, 1.74) of attaining ≥3 treatment targets than women.

INTERPRETATION: Asian women with T2D had worse quality of care than men especially in middle-income countries/areas, calling for targeted implementation programs to close these care gaps.

SPONSOR: Asia Diabetes Foundation.

FUNDING: Nil.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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