TY - JOUR
T1 - Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function
T2 - The Maastricht Study
AU - de Ritter, Rianneke
AU - Sep, Simone J.S.
AU - van der Kallen, Carla J.H.
AU - van Greevenbroek, Marleen M.J.
AU - de Jong, Marit
AU - Vos, Rimke C.
AU - Bots, Michiel L.
AU - Reulen, Jos P.H.
AU - Houben, Alfons J.H.M.
AU - Webers, Carroll A.B.
AU - Berendschot, Tos T.J.M.
AU - Dagnelie, Pieter C.
AU - Eussen, Simone J.P.M.
AU - Schram, Miranda T.
AU - Koster, Annemarie
AU - Peters, Sanne A.E.
AU - Stehouwer, Coen D.A.
N1 - Funding Information:
This study was supported by ZonMw (Project No. 849200001), the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (Grant 31O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), CARIM, School for Cardiovascular Diseases (Maastricht, the Netherlands), School CAPHRI, Care and Public Health Research Institute (Maastricht, the Netherlands), NUTRIM, School of Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands) and by unrestricted grants from Janssen-Cilag B.V. (Tilburg, the Netherlands), Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands) and Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands).
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/5/7
Y1 - 2021/5/7
N2 - Background: Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods: In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results: Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions: Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.
AB - Background: Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods: In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results: Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions: Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.
KW - Adult
KW - Aged
KW - Biomarkers/blood
KW - Blood Glucose/metabolism
KW - Cross-Sectional Studies
KW - Diabetes Mellitus, Type 2/blood
KW - Diabetic Angiopathies/blood
KW - Diabetic Nephropathies/blood
KW - Diabetic Neuropathies/blood
KW - Diabetic Retinopathy/blood
KW - Female
KW - Health Status Disparities
KW - Humans
KW - Male
KW - Microcirculation
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Prediabetic State/blood
KW - Prevalence
KW - Prognosis
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Sex Factors
KW - Type 2 diabetes
KW - Retinopathy
KW - Sex
KW - Neuropathy
KW - Microvascular complications
KW - Epidemiology
KW - Women
KW - Sex difference
KW - Nephropathy
UR - http://www.scopus.com/inward/record.url?scp=85105429198&partnerID=8YFLogxK
U2 - 10.1186/s12933-021-01290-x
DO - 10.1186/s12933-021-01290-x
M3 - Article
C2 - 33962619
AN - SCOPUS:85105429198
SN - 1475-2840
VL - 20
SP - 1
EP - 15
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 102
ER -