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Gender And Outcomes in Type 2 Diabetes Mellitus 49
and Cardiovascular Disease

Based on the guidelines from the National Heart, op impaired fasting glucose (IFG), whereas women
Lung, and Blood Institute (NHLBI) and the American more often show Impaired Glucose Tolerance (IGT).
Heart Association (AHA), any three of the following IFG is characterized by increased hepatic glucose
traits in the same individual meet the criteria for the output and impaired early insulin secretion, whereas
metabolic syndrome: IGT is primarily due to peripheral insulin resistance. It
further highlights the importance of performing oral
• Abdominal obesity: a waist circumference of Asian, glucose tolerance tests to screen for IGT, especially
the cutoff values are ≥90 cm (35 in) in men or ≥80 in women.
cm (32 in) in women
• Serum triglycerides 150 mg/dl or above. Psychosocial Risk Factors

• HDL cholesterol 40mg/dl or lower in men and Social factors, like low educational level, occupation,
50mg/dl or lower in women. and income with low socioeconomic status (SES),
largely contribute to unhealthy lifestyle behavior and
• Blood pressure of 130/85 or more.
social disparities and thus are related to higher risk of
• Fasting blood glucose of 100 mg/dl obesity and T2DM particularly in women. Females ap-
pear to be more vulnerable to the so-called “allostatic
MetS, a term used for clustering of metabolic risk
factors with insulin resistance disregard risk factors load,” the imbalance between the ability to adapt to
like age, sex, family history, SES, and lifestyle. Di- environmental demands and overexposure to envi-
abetes appears to diminish the favorable cluster of ronmental stress. Women at all ages were shown to
risk factors of females compared with males and in- be at a 40% higher risk for suffering from insomnia,
creases the chances of cardiovascular complications. which in turn was associated with insulin resistance
and obesity.
5) Adipokines (Leptins and Adiponectins)

These are important in the regulation of satiety, food Cardiovascular Complications
intake, and energy expenditure. They also influence The Global Burden of Cardiovascular Disease in
the insulin glucose axis as well as peripheral insu- Women
lin resistance. Women show an up-regulation of ex- • Cardiovascular disease is the leading cause of
pression of adiponectin and its receptor in abdominal death for women worldwide.
adipose tissue, possibly contributing to their lower
cardiometabolic risk. Adiponectin and waist circum- • One-third of deaths in women are due to cardio-
ference (WCR) are important predictors of insulin-re- vascular disease.
sistance even in healthy non-diabetic women, they • Each year, 8.6 million women around the globe
may open a new opportunity to improve current risk die from heart disease and stroke.
estimation.
Sex-Specific Differences in Complications and Co-
6) New biomarkers
morbidities of Diabetes is illustrated in the attached
The following new biomarkers show promise in fu- Figure 1.
ture for prediction of diabetes in women.
Coronary heart disease
1) Hepatokine fetuin A
2) copeptin Coronary artery disease in women tends to affect the
3) Proneurotensin smaller blood vessels, producing less-severe symp-
toms. The plaque burden in women also tends to be
7) Imbalance of sex hormones
lower than in men but differs in that it often builds
The polycystic ovary syndrome (PCOS) describes a up along the entire artery rather than within a con-
female-specific state of androgen excess and hyper- centrated area. This means that it is not uncommon
insulinemia related to obesity, T2DM, and higher car- for women to have chest pain without evident ob-
dio metabolic risk. Testosterone replacement therapy structive coronary artery disease.
can improve insulin sensitivity and hyperglycemia in In newly diagnosed diabetic subjects without clini-
hypogonadal diabetic males. cal CVD, increased atherosclerosis and higher inti-
8) Prediabetes ma media thickness was found in carotid arteries.
Subgroup analysis revealed that as opposed to male
Prediabetic categories differ between sexes giving groups, carotid atherosclerosis was more prevalent in
rise to clinical implications: men more often devel-
newly diagnosed diabetic women than in nondiabet-

Cardio Diabetes Medicine