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Erschienen in: Wiener klinische Wochenschrift 21-22/2012

01.11.2012 | original article

Sex-specific differences in long-term glycemic control and cardiometabolic parameters in patients with type 1 diabetes treated at a tertiary care centre

Gender aspects in type 1 diabetes

verfasst von: Christian S. Göbl, MD PhD, Latife Bozkurt, MD, Johannes Lueck, Mona El-Samahi, Peter Grösser, MSc, Martin Clodi, MD, Anton Luger, MD, Alexandra Kautzky-Willer, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 21-22/2012

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Summary

Background

Time-dependent changes in glycemic control might represent a strong predictor for coronary artery disease. Since a higher benefit from outpatient appointments has been discussed for female gender, the aim of the study was to assess gender differences in HbA1c levels and metabolic parameters at baseline as well as over 3 years of follow-up.

Methods

We analyzed the data of 54 female and 65 male type 1 diabetic patients, with comparable age and diabetes duration, who visited our diabetes outpatient clinic in the year 2006 as well as the follow-up visits until 2009.

Results

In 2006, females showed higher HbA1c levels as compared to male subjects (8.59 ± 1.60 vs. 7.75 ± 1.41, p = 0.003). Longitudinal analysis revealed that the decrease in HbA1c until 2009 was more pronounced in women (decreased to 7.52 ± 1.00) than in men (decreased to 7.50 ± 0.99, p sex:time = 0.006); however, the significance was lost after adjusting for baseline levels. Further, females showed higher levels in total-cholesterol (p = 0.001), LDL-cholesterol (p = 0.033), and HDL-cholesterol (p < 0.001) at baseline, whereas males had higher creatinine (p = 0.001) and uric acid levels (p < 0.001). No differences between the two sexes were shown for triglycerides at 2006. Additionally, uric acid levels were negatively associated with long term glycemic control, particularly in male patients.

Conclusions

Sex-related differences in metabolic parameters are present in patients with type 1 diabetes. Especially, our data suggests more adverse cardiometabolic risk markers in females. A potentially protective effect for hyperuricemia by hyperglycemia-related glucosuria is lacking in female patients with type 1 diabetes.
Literatur
1.
Zurück zum Zitat Kautzky-Willer A, Handisurya A. Metabolic diseases and associated complications: sex and gender matter! Eur J Clin Invest. 2009;39:631–48.PubMedCrossRef Kautzky-Willer A, Handisurya A. Metabolic diseases and associated complications: sex and gender matter! Eur J Clin Invest. 2009;39:631–48.PubMedCrossRef
2.
Zurück zum Zitat Legato MJ, Gelzer A, Goland R, et al. Writing group for the partnership for gender-specific medicine. Gender-specific care of the patient with diabetes: review and recommendations. Gend Med. 2006;3:131–58.PubMedCrossRef Legato MJ, Gelzer A, Goland R, et al. Writing group for the partnership for gender-specific medicine. Gender-specific care of the patient with diabetes: review and recommendations. Gend Med. 2006;3:131–58.PubMedCrossRef
3.
Zurück zum Zitat Auryan S, Itamar R. Gender specific care of diabetes mellitus: particular considerations in the management of diabetic women. Diabetes Obes Metab. 2008;10:1135–56.PubMed Auryan S, Itamar R. Gender specific care of diabetes mellitus: particular considerations in the management of diabetic women. Diabetes Obes Metab. 2008;10:1135–56.PubMed
5.
Zurück zum Zitat Ostermann J, Lönnberg G, Arnquist HJ, Blohmé G, Bolinder J, Ekbom Schell A, Eriksson JW, Gudbjörnsdottir S, Sundkvist G, Nyström L. Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002. J Intern Med. 2008;263:386–94.CrossRef Ostermann J, Lönnberg G, Arnquist HJ, Blohmé G, Bolinder J, Ekbom Schell A, Eriksson JW, Gudbjörnsdottir S, Sundkvist G, Nyström L. Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002. J Intern Med. 2008;263:386–94.CrossRef
6.
Zurück zum Zitat Gerstl EM, Rabl W, Gröbe H, Hofer SE, Krause U, Holl RW. Metabolic control as reflected by HbA1c in children, adolescents and young adults with type 1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade. Eur J Pediatr. 2008;167:447–53.PubMedCrossRef Gerstl EM, Rabl W, Gröbe H, Hofer SE, Krause U, Holl RW. Metabolic control as reflected by HbA1c in children, adolescents and young adults with type 1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade. Eur J Pediatr. 2008;167:447–53.PubMedCrossRef
7.
Zurück zum Zitat Schwab KO, Doerfer J, Naeke A, Rohrer T, Wiedmann D, Marg W, Hofer SE, Holl RW, on behalf of the German/Austrian Pediatric DPV Initiative. Influence of food intake, age, gender, HbA1c, and BMI levels on plasma cholesterol in 29,979 children and adolescents with type 1 diabetes—reference data from the German diabetes documentation and quality management system (DPV). Pediatric Diabetes. 2009;10:184–92. Schwab KO, Doerfer J, Naeke A, Rohrer T, Wiedmann D, Marg W, Hofer SE, Holl RW, on behalf of the German/Austrian Pediatric DPV Initiative. Influence of food intake, age, gender, HbA1c, and BMI levels on plasma cholesterol in 29,979 children and adolescents with type 1 diabetes—reference data from the German diabetes documentation and quality management system (DPV). Pediatric Diabetes. 2009;10:184–92.
8.
Zurück zum Zitat Idzior-Walus B, Mattock MB, Solnica B, Stevens L, Fuller JH, et al. Factors associated with plasma lipids and lipoproteins in type 1 diabetes mellitus: the EURODIAB IDDM complication study. Diabetic Medicine. 2001;18:786–96.PubMedCrossRef Idzior-Walus B, Mattock MB, Solnica B, Stevens L, Fuller JH, et al. Factors associated with plasma lipids and lipoproteins in type 1 diabetes mellitus: the EURODIAB IDDM complication study. Diabetic Medicine. 2001;18:786–96.PubMedCrossRef
9.
Zurück zum Zitat Sparud-Lundin C, Öhrn I, Danielson E, Forsander G. Glycemic control and diabetes care utilization in young adults with type 1 diabetes. Diabetic Medicine. 2008;25:968–73.PubMedCrossRef Sparud-Lundin C, Öhrn I, Danielson E, Forsander G. Glycemic control and diabetes care utilization in young adults with type 1 diabetes. Diabetic Medicine. 2008;25:968–73.PubMedCrossRef
10.
Zurück zum Zitat Prince CT, Becker DJ, Costacou T, Miller RG, Orchard TJ. Changes in glycemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). Diabetologia. 2007;50:2280–88.PubMedCrossRef Prince CT, Becker DJ, Costacou T, Miller RG, Orchard TJ. Changes in glycemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). Diabetologia. 2007;50:2280–88.PubMedCrossRef
11.
Zurück zum Zitat Soedamah-Muthu SS, Chaturvedi N, Toeller M, Ferriss B, Reboldi P, Michel G, Manes C, Fuller JH, et al. Risk factors for coronary heart disease in type 1 diabetic patients in Europe. The EURODIAB prospective complications study. Diabetes Care. 2004;27:530–37.PubMedCrossRef Soedamah-Muthu SS, Chaturvedi N, Toeller M, Ferriss B, Reboldi P, Michel G, Manes C, Fuller JH, et al. Risk factors for coronary heart disease in type 1 diabetic patients in Europe. The EURODIAB prospective complications study. Diabetes Care. 2004;27:530–37.PubMedCrossRef
12.
Zurück zum Zitat American Diabetes Association. Diagnosis and classification of Diabetes Mellitus. Diabetes Care. 2010;33(S1):62–9. American Diabetes Association. Diagnosis and classification of Diabetes Mellitus. Diabetes Care. 2010;33(S1):62–9.
13.
Zurück zum Zitat Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.PubMedCrossRef Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.PubMedCrossRef
14.
Zurück zum Zitat Barnett AG, Van Der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol. 2005;34:215–20.PubMedCrossRef Barnett AG, Van Der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol. 2005;34:215–20.PubMedCrossRef
15.
Zurück zum Zitat Morton V, Torgerson J. Effect of the regression to the mean on decision making in the health care. BMJ. 2003;326:1083–84.PubMedCrossRef Morton V, Torgerson J. Effect of the regression to the mean on decision making in the health care. BMJ. 2003;326:1083–84.PubMedCrossRef
16.
Zurück zum Zitat Kacerovsky-Bielesz G, Lienhardt S, Hagenhofer M, Kacerovsky M, Forster E, Roth R, Roden M. Sex-related psychological effects on metabolic control in type 2 diabetes mellitus. Diabetologia. 2009;52:781–88.PubMedCrossRef Kacerovsky-Bielesz G, Lienhardt S, Hagenhofer M, Kacerovsky M, Forster E, Roth R, Roden M. Sex-related psychological effects on metabolic control in type 2 diabetes mellitus. Diabetologia. 2009;52:781–88.PubMedCrossRef
17.
Zurück zum Zitat The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. NEJM. 1993;329:977–86.CrossRef The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. NEJM. 1993;329:977–86.CrossRef
18.
Zurück zum Zitat Jenkins AJ, Lyons TJ, Zheng D, Otvos JD, Lackland DT, McGee D, Garvey WT, Klein RL, The DCCT/EDIC Research Group. Serum lipoproteins in the diabetes control and complications trial/epidemiology of diabetes intervention and complications cohort. Diabetes Care. 2003;26:810–18. Jenkins AJ, Lyons TJ, Zheng D, Otvos JD, Lackland DT, McGee D, Garvey WT, Klein RL, The DCCT/EDIC Research Group. Serum lipoproteins in the diabetes control and complications trial/epidemiology of diabetes intervention and complications cohort. Diabetes Care. 2003;26:810–18.
19.
Zurück zum Zitat Nádas J, Putz Z, Fövényi J, Gaál Z, Gyimesi A, Hidvégi T, Hosszúfalusi N, Neuwirth G, Oroszlán T, Pánczél P, Széles G, Vandorfi G, Winkler G, Wittmann I, Jermendy G. Cardiovascular risk factor characteristic for the metabolic syndrome in adult patients with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2009;117:107–12.PubMedCrossRef Nádas J, Putz Z, Fövényi J, Gaál Z, Gyimesi A, Hidvégi T, Hosszúfalusi N, Neuwirth G, Oroszlán T, Pánczél P, Széles G, Vandorfi G, Winkler G, Wittmann I, Jermendy G. Cardiovascular risk factor characteristic for the metabolic syndrome in adult patients with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2009;117:107–12.PubMedCrossRef
20.
Zurück zum Zitat Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Wadén J, Rönnback M, Rosengard-Bärlund M, Björkesten CG, Taskinen MR, Groop PH, FinnDiane Study group. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care. 2005;28:2019–24.PubMedCrossRef Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Wadén J, Rönnback M, Rosengard-Bärlund M, Björkesten CG, Taskinen MR, Groop PH, FinnDiane Study group. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care. 2005;28:2019–24.PubMedCrossRef
21.
Zurück zum Zitat Metascreen Writing Committee. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes. Results from Metascreen, a multicenter diabetes clinic-based survey. Diabetes Care. 2006;29:2701–07.CrossRef Metascreen Writing Committee. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes. Results from Metascreen, a multicenter diabetes clinic-based survey. Diabetes Care. 2006;29:2701–07.CrossRef
22.
Zurück zum Zitat Pambianco G, Costacou T, Orchard TJ. The prediction of major outcomes of type 1 diabetes: a 12-year prospective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate: the Pittsburgh epidemiology of diabetes complications study experience. Diabetes Care. 2007;30:1248–54.PubMedCrossRef Pambianco G, Costacou T, Orchard TJ. The prediction of major outcomes of type 1 diabetes: a 12-year prospective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate: the Pittsburgh epidemiology of diabetes complications study experience. Diabetes Care. 2007;30:1248–54.PubMedCrossRef
23.
Zurück zum Zitat Göbl CS, Brannath W, Bozkurt L, Handisurya A, Anderwald C, Luger A, Krebs M, Kautzky-Willer A, Bischof MG. Sex-specific differences in glycemic control and cardiovascular risk factors in elderly patients with insulin-treated type 2 diabetes mellitus. Gender Medicine. 2010;7:593–99.PubMedCrossRef Göbl CS, Brannath W, Bozkurt L, Handisurya A, Anderwald C, Luger A, Krebs M, Kautzky-Willer A, Bischof MG. Sex-specific differences in glycemic control and cardiovascular risk factors in elderly patients with insulin-treated type 2 diabetes mellitus. Gender Medicine. 2010;7:593–99.PubMedCrossRef
24.
Zurück zum Zitat Maric C. Risk factors for cardiovascular disease in women with diabetes. Gend Med. 2010;7:551–56.PubMedCrossRef Maric C. Risk factors for cardiovascular disease in women with diabetes. Gend Med. 2010;7:551–56.PubMedCrossRef
25.
Zurück zum Zitat Rodriguez G, Soriano LC, Choi HK. Impact of diabetes against the future risk of developing gout. Ann Rheum Dis. 2010;69:2090–94.PubMedCrossRef Rodriguez G, Soriano LC, Choi HK. Impact of diabetes against the future risk of developing gout. Ann Rheum Dis. 2010;69:2090–94.PubMedCrossRef
26.
Zurück zum Zitat Sui X, Church TS, Meriwether RA, Lobelo F, Blair SN. Uric acid and the development of metabolic syndrome in women and men. Metabolism. 2008;57:845–52.PubMedCrossRef Sui X, Church TS, Meriwether RA, Lobelo F, Blair SN. Uric acid and the development of metabolic syndrome in women and men. Metabolism. 2008;57:845–52.PubMedCrossRef
27.
Zurück zum Zitat Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 1995;141:637–44.PubMed Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 1995;141:637–44.PubMed
28.
Zurück zum Zitat Choi HK, Ford ES. Hemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels—the Third National Health and Nutrition Examination Survey. Rheumatology. 2008;47:713–17.PubMedCrossRef Choi HK, Ford ES. Hemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels—the Third National Health and Nutrition Examination Survey. Rheumatology. 2008;47:713–17.PubMedCrossRef
29.
Zurück zum Zitat Chou P, Lin KC, Lin HY, Tsai ST. Gender differences in the relationship of serum uric acid with fasting serum insulin and plasma glucose in patients without diabetes. J Rheumatol. 2001;28:571–76.PubMed Chou P, Lin KC, Lin HY, Tsai ST. Gender differences in the relationship of serum uric acid with fasting serum insulin and plasma glucose in patients without diabetes. J Rheumatol. 2001;28:571–76.PubMed
30.
Zurück zum Zitat Kautzky-Willer A, Dorner T, Jensby A, Rieder A. Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS. BMC Public Health. 2012;12. doi:10.1186/1471-2458-12-392. Kautzky-Willer A, Dorner T, Jensby A, Rieder A. Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS. BMC Public Health. 2012;12. doi:10.1186/1471-2458-12-392.
Metadaten
Titel
Sex-specific differences in long-term glycemic control and cardiometabolic parameters in patients with type 1 diabetes treated at a tertiary care centre
Gender aspects in type 1 diabetes
verfasst von
Christian S. Göbl, MD PhD
Latife Bozkurt, MD
Johannes Lueck
Mona El-Samahi
Peter Grösser, MSc
Martin Clodi, MD
Anton Luger, MD
Alexandra Kautzky-Willer, MD
Publikationsdatum
01.11.2012
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 21-22/2012
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-012-0246-6

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