Gender gaps in type 1 diabetes care
Tóm tắt
Diabetes mellitus is one of the largest global health concerns of recent times. Women with diabetes mellitus have a higher excess risk of all-cause mortality and more vascular events than men. Focusing on type 1 diabetes, this could be caused by gender inequalities in delivered diabetes care. This study aims to assess gender differences in type 1 diabetes outpatient care, particularly diagnostics and outcomes. This cross-sectional cohort study included all adult type 1 diabetes patients in the Dutch Pediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics between 2016–2021. The frequency of process measurements, including physical examination and laboratory testing, was assessed among both sexes after adjustment for age and body mass index. Gender differences in eGFR ≥ 60, BMI-, and control in blood pressure and LDL-cholesterol were evaluated. Hospital variation in achieving HbA1c targets of 53 mmol/mol and median HbA1c were assessed. Cardiovascular risk scores were calculated in men and women using the Systematic Coronary Risk Evaluation (SCORE) European low-risk chart. Our study showed a 17% higher odds of reaching weight control and a 23% lower odds of achieving blood pressure targets in men than women. Gender-skewed cardiovascular mortality risk scores were found. Gender disparities in outcomes appear not to be caused by gender-biased attitudes in healthcare professionals since no gender differences were found in the performance of process measurements in type 1 diabetes care. In addition, hospitals appear to vary by extent of gender differences in achieving a target HbA1c of 53 mmol/mol. Gender equality exists in the diagnostic process of diabetes care. However, differences in weight control, blood pressure control, and cardiovascular mortality risk scores remain between both sexes, most likely due to multifactorial causes. Indications for interhospital variation in gender disparities in HbA1c control exist. Further focus on performance of process measurements between hospitals may identify areas for improvement of gender-skewed outcomes to further enhance Dutch diabetes care for both sexes.
Tài liệu tham khảo
International Diabetes Federation (2019) IDF Diabetes Atlas 9th edition
Huxley RR, Peters SAE, Mishra GD, Woodward M (2015) Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3:198–206. https://doi.org/10.1016/S2213-8587(14)70248-7
Huxley R, Barzi F, Woodward M (2006) Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 332:73–76. https://doi.org/10.1136/BMJ.38678.389583.7C
Manicardi V, Russo G, Napoli A et al (2016) Gender-disparities in adults with type 1 diabetes: more than a quality of care issue. A cross-sectional observational study from the AMD annals initiative. PLOS ONE 11(10):e0162960. https://doi.org/10.1371/journal.pone.0162960
Ou HT, Lee TY, Li CY et al (2017) Incidence of diabetes-related complications in Chinese patients with type 1 diabetes: a population-based longitudinal cohort study in Taiwan. BMJ Open. https://doi.org/10.1136/bmjopen-2016-015117
Healy B (1991) The yentl syndrome. N Engl J Med 325:274–276. https://doi.org/10.1056/nejm199107253250408
Gulati M (2019) Yentl’s bikini: sex differences in STEMI. J Am Heart Assoc 8:e012873–e012873
Hyun KK, Redfern J, Patel A et al (2017) Gender inequalities in cardiovascular risk factor assessment and management in primary healthcare. Heart 103:492–498. https://doi.org/10.1136/HEARTJNL-2016-310216
Koopman C, Vaartjes I, Heintjes EM et al (2013) Persisting gender differences and attenuating age differences in cardiovascular drug use for prevention and treatment of coronary heart disease, 1998–2010. Eur Heart J 34:3198–3205. https://doi.org/10.1093/EURHEARTJ/EHT368
Rossi MC, Cristofaro MR, Gentile S et al (2013) Sex disparities in the quality of diabetes care: Biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the amd annals initiative. Diabetes Care 36:3162–3168. https://doi.org/10.2337/dc13-0184
Williams JS, Bishu K, Dismuke CE, Egede LE (2017) Sex differences in healthcare expenditures among adults with diabetes: evidence from the medical expenditure panel survey, 2002–2011. BMC Health Serv Res 17:259. https://doi.org/10.1186/s12913-017-2178-3
Bak JCG, Mul D, Serné EH et al (2021) DPARD: rationale, design and initial results from the dutch national diabetes registry. BMC Endocr Disord. https://doi.org/10.1186/S12902-021-00782-X
Management (2020) MMRD Home | MRDM. https://mrdm.nl/. Accessed 20 Mar 2020
Mayer-Davis EJ, Kahkoska AR, Jefferies C et al (2018) ISPAD clinical practice consensus guidelines 2018: definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 19:7–19. https://doi.org/10.1111/pedi.12773
Association AD (2020) Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 43:S14–S31. https://doi.org/10.2337/dc20-S002
Conroy R (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Europ Heart J 24(11):987–1003. https://doi.org/10.1016/S0195-668X(03)00114-3
Zhou B, Carrillo-Larco RM, Danaei G et al (2021) Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 398:957–980. https://doi.org/10.1016/S0140-6736(21)01330-1/ATTACHMENT/647D2630-0ABA-4985-B5C7-D4CA0A7F09E4/MMC1.PDF
Thoenes M, Neuberger HR, Volpe M et al (2010) (2009) Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 245(24):336–344. https://doi.org/10.1038/JHH.2009.76
Rawshani A, Rawshani A, Franzén S et al (2017) Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med 376:1407–1418. https://doi.org/10.1056/NEJMOA1608664/SUPPL_FILE/NEJMOA1608664_DISCLOSURES.PDF
Van DI, Kromhout D, Geleijnse JM et al (2010) Evaluation of cardiovascular risk predicted by different SCORE equations: the Netherlands as an example. Eur J Cardiovasc Prev Rehabil 17:244–249. https://doi.org/10.1097/HJR.0B013E328337CCA2
Mikkola TS, Gissler M, Merikukka M et al (2013) Sex differences in age-related cardiovascular mortality. PLoS One. https://doi.org/10.1371/JOURNAL.PONE.0063347
Lamidi ML, Wikström K, Inglin L et al (2020) Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017. BMC Fam Pract 21:1–11. https://doi.org/10.1186/S12875-020-01324-5/FIGURES/3
Juutilainen A, Kortelainen S, Lehto S et al (2004) Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care 27:2898–2904. https://doi.org/10.2337/DIACARE.27.12.2898
Beverly EA, Ganda OP, Ritholz MD et al (2012) Look who’s (not) talking. Diabetes Care 35:1466–1472. https://doi.org/10.2337/DC11-2422
Cheung A, Stukel TA, Alter DA et al (2017) Primary care physician volume and quality of diabetes care: a population-based cohort study. Ann Intern Med 166:240–247. https://doi.org/10.7326/M16-1056
Coombs LJ, Burston B, Liu D (2017) Importance of an alternative approach to measuring quality in a volume-to-value world: a case study of diabetes care. BMJ Open Qual 6:e000216. https://doi.org/10.1136/bmjoq-2017-000216
Voeten DM, Gisbertz SS, Ruurda JP et al (2021) Overall volume trends in esophageal cancer surgery results from the dutch upper gastrointestinal cancer audit. Ann Surg 274:449–458. https://doi.org/10.1097/SLA.0000000000004985
Group TDC and CTR (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986. https://doi.org/10.1056/NEJM199309303291401
Imai C, Li L, Hardie RA, Georgiou A (2021) Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Qual Saf 30:706–714. https://doi.org/10.1136/bmjqs-2020-012026
Hu Z, Melton GB, Arsoniadis EG et al (2017) Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record. J Biomed Inform 68:112–120. https://doi.org/10.1016/j.jbi.2017.03.009