Diabetic women get less intense treatment of heart disease than men

Women with type 2 diabetes and heart disease have poorer control of both diseases and receive less intensive medical treatment than do men, a large new study found. The results have been presented Sunday, June 15, at The Endocrine Society’s 90th Annual Meeting in San Francisco.

The findings of the study, performed at three German universities, may indicate why death due to heart disease has decreased among diabetic men but not in women with type 2 diabetes, said the study’s primary author. Ioanna Gouni-Berthold, MD, professor of medicine at the University of Cologne, led the study.

“Our study shows that in patients with diabetes there is a clear disparity between men and women in the control and treatment of important modifiable risk factors for cardiovascular disease,” Gouni-Berthold said. “Women have worse control of their blood pressure, blood sugar and cholesterol levels compared to men and are given cholesterol-lowering medications less often.”

Gouni-Berthold and researchers from the University of Bonn and University of Homburg studied nearly 45,000 people with type 2 diabetes treated as outpatients by private-practice physicians from 2002 to 2003. Of the patients, 9,521 men and 8,050 women had heart and vascular disease.

There were no gender differences in the intensity of medication management or most heart disease risk factors among diabetic patients who did not have heart disease, the study found. However, in the group with cardiovascular disease, women were 44 percent more likely than men to have high LDL (“bad”) cholesterol, yet 15 percent less likely to receive lipid-lowering medications, the authors reported. Women also were 19 percent more likely than men to have uncontrolled high blood pressure.

In addition, women were 15 percent more likely to have poor long-term control of their blood glucose (sugar) level, as shown by a hemoglobin A1c blood test above 8 percent. The recommended A1c level for adults with type 2 diabetes is less than 7 percent.

The findings are cause for concern, according to Gouni-Berthold, because there is evidence that diabetes cancels the protective effect of female sex on the risk of heart disease.

“More aggressive treatment of cardiovascular disease in women with diabetes may improve the gender disparity in cardiovascular disease mortality,” she said. “Patients should speak with their doctors about the intensity of treatment modalities.”

The study patients were part of the German DUTY (Diabetes mellitus needs unrestricted evaluation of patient data to yield treatment progress) Registry. Merck Sharp & Dohme provided a research grant that funded the registry. However, the pharmaceutical company had no influence on data analysis, according to Gouni-Berthold.