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48 Cardio Diabetes Medicine 2017

Gender And Outcomes in Type 2 Diabetes

Mellitus and Cardiovascular Disease

Dr Prema Tirou,
MRCP (UK), MRCGP (UK), D. Diabetes (UK)

Abstract distinction between sex and gender differences may
There is increasing evidence of major clinically im- be difficult. (2)
portant differences in outcome between the genders In this article, the following topics are discussed
in Type 2 Diabetes Mellitus (T2DM). Diabetes seems namely biological and psychosocial risk factors and
to undermine the protective effect of the female sex cardiovascular complications in both genders.
in the development of cardiovascular disease (CVD).
A review of the literature shows that women with Biological Risk Factors
T2DM often have worse CVD risk profiles and out- 1) Body Mass index (BMI) related risk
comes compared with men. Women with diabetes
have a three- to fivefold higher risk of developing Diabetes in men is diagnosed 3–4 years earlier and
CVD, and men have a two to threefold higher risk at a BMI 1–3 kg/m lower. This trend was partly ex-
2
compared with their respective counterparts with- plained by an increase of automation and decrease
out diabetes. There exist other differences including: of physical work particularly in men. Diabetic women,
T2DM is diagnosed at lower age and body mass in- on the other hand, are more obese than diabetic men
dex in men; Obesity, as a risk factor, is more com- in most studies and show a stronger association be-
mon in women. The disparities could be due to both tween increase of BMI and diabetes risk. (3)
biological and psychosocial factors. However, the 2) Body fat distribution
cause for the various gender disparities in T2DM out-
comes remains unclear and future research should In an Asian population, women with normal waist
provide us with more insight into this. Future treat- circumference (WCR) and BMI were diagnosed with
ment of T2DM should be with gender based targets visceral obesity by computer tomography. This even
to achieve better outcomes. showed greater cardio metabolic risk in women, in
terms of glucose and lipid abnormalities compared
Introduction with males and the visceral obesity increases the risk
of diabetes more in women.
The disparities in T2DM outcomes between men and
women could be attributed to sex differences and 3) Brown adipose tissue (BAT)
gender differences.
Sex differences are described regarding mass and
Sex differences describe differences between wom- activity of BAT in adults which will impact whole-body
en and men which are caused by biological aspects energy metabolism, insulin resistance, and obesi-
such as differences in sex chromosomes, sex-spe- ty-related T2DM. Women have much higher preva-
cific gene expression of autosomes, sex hormones, lence and activity of BAT, which protects them from
and their effects on organ systems. (1) diabetes and cardiovascular risk.BAT transplantation
reversed obesity, increased adiponectin, and reduced
Gender differences arise from sociocultural process-
es, such as different behaviors of women and men, insulin resistance and liver steatosis in leptin-defi-
exposure to specific environmental influences, differ- cient animals.
ences in nutrition, life styles or stress, or attitudes 4) Metabolic syndrome
towards treatments and prevention. In reality, the

GCDC 2017