Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study
Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = ...
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| Published in | Cardiovascular diabetology Vol. 20; no. 1; pp. 102 - 15 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
07.05.2021
BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1475-2840 1475-2840 |
| DOI | 10.1186/s12933-021-01290-x |
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| Abstract | Background
Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures.
Methods
In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders.
Results
Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation.
Conclusions
Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. |
|---|---|
| AbstractList | Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures.BACKGROUNDWomen with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures.In a population-based cohort study of individuals aged 40-75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders.METHODSIn a population-based cohort study of individuals aged 40-75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders.Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: - 0.74% (- 1.22; - 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (- 3.50;4.07) and: - 0.52% (- 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation.RESULTSMen with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: - 0.74% (- 1.22; - 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (- 3.50;4.07) and: - 0.52% (- 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation.Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.CONCLUSIONSOur findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. In a population-based cohort study of individuals aged 40-75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: - 0.74% (- 1.22; - 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (- 3.50;4.07) and: - 0.52% (- 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. Abstract Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. |
| ArticleNumber | 102 |
| Author | Schram, Miranda T. Koster, Annemarie Webers, Carroll A. B. Berendschot, Tos T. J. M. Houben, Alfons J. H. M. Peters, Sanne A. E. van der Kallen, Carla J. H. Eussen, Simone J. P. M. de Jong, Marit Reulen, Jos P. H. Stehouwer, Coen D. A. Dagnelie, Pieter C. van Greevenbroek, Marleen M. J. de Ritter, Rianneke Sep, Simone J. S. Bots, Michiel L. Vos, Rimke C. |
| Author_xml | – sequence: 1 givenname: Rianneke orcidid: 0000-0003-2858-1874 surname: de Ritter fullname: de Ritter, Rianneke email: rianneke.de.ritter@mumc.nl organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University – sequence: 2 givenname: Simone J. S. surname: Sep fullname: Sep, Simone J. S. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Adelante, Centre of Expertise in Rehabilitation and Audiology – sequence: 3 givenname: Carla J. H. surname: van der Kallen fullname: van der Kallen, Carla J. H. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University – sequence: 4 givenname: Marleen M. J. surname: van Greevenbroek fullname: van Greevenbroek, Marleen M. J. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University – sequence: 5 givenname: Marit surname: de Jong fullname: de Jong, Marit organization: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University – sequence: 6 givenname: Rimke C. surname: Vos fullname: Vos, Rimke C. organization: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Leiden University Medical Center, Dept Public Health and Primary Care/LUMC-Campus – sequence: 7 givenname: Michiel L. surname: Bots fullname: Bots, Michiel L. organization: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University – sequence: 8 givenname: Jos P. H. surname: Reulen fullname: Reulen, Jos P. H. organization: Department of Clinical Neurophysiology, Maastricht University Medical Center+ – sequence: 9 givenname: Alfons J. H. M. surname: Houben fullname: Houben, Alfons J. H. M. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University – sequence: 10 givenname: Carroll A. B. surname: Webers fullname: Webers, Carroll A. B. organization: Department of Ophthalmology, Maastricht University Medical Center+ – sequence: 11 givenname: Tos T. J. M. surname: Berendschot fullname: Berendschot, Tos T. J. M. organization: Department of Ophthalmology, Maastricht University Medical Center+ – sequence: 12 givenname: Pieter C. surname: Dagnelie fullname: Dagnelie, Pieter C. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University – sequence: 13 givenname: Simone J. P. M. surname: Eussen fullname: Eussen, Simone J. P. M. organization: CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Department of Epidemiology, Maastricht University – sequence: 14 givenname: Miranda T. surname: Schram fullname: Schram, Miranda T. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Heart and Vascular Centre, Maastricht University Medical Centre+ – sequence: 15 givenname: Annemarie surname: Koster fullname: Koster, Annemarie organization: Department of Social Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht University – sequence: 16 givenname: Sanne A. E. surname: Peters fullname: Peters, Sanne A. E. organization: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The George Institute for Global Health, University of Oxford, The George Institute for Global Health, University of New South Wales – sequence: 17 givenname: Coen D. A. surname: Stehouwer fullname: Stehouwer, Coen D. A. organization: Department of Internal Medicine, Maastricht University Medical Centre+, CARIM Cardiovascular Research Institute Maastricht, Maastricht University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33962619$$D View this record in MEDLINE/PubMed |
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| Keywords | Type 2 diabetes Women Nephropathy Retinopathy Sex Neuropathy Microvascular complications Epidemiology Sex difference |
| Language | English |
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| PublicationTitle | Cardiovascular diabetology |
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Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for... Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular... Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for... Abstract Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the... |
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| SubjectTerms | Adult Aged Alcohol use Angiology Biomarkers - blood Blood glucose Blood Glucose - metabolism Cardiology Cross-Sectional Studies Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - physiopathology Diabetic Angiopathies - blood Diabetic Angiopathies - diagnosis Diabetic Angiopathies - epidemiology Diabetic Angiopathies - physiopathology Diabetic Nephropathies - blood Diabetic Nephropathies - epidemiology Diabetic Nephropathies - physiopathology Diabetic Neuropathies - blood Diabetic Neuropathies - epidemiology Diabetic Neuropathies - physiopathology Diabetic neuropathy Diabetic Retinopathy - blood Diabetic Retinopathy - epidemiology Diabetic Retinopathy - physiopathology Epidemiology Female Gender differences Generalized linear models Glucose Glucose metabolism Health Status Disparities Humans Kidney diseases Laboratories Male Medicine Medicine & Public Health Metabolism Microcirculation Microvascular complications Microvasculature Middle Aged Nephropathy Netherlands - epidemiology Original Investigation Pain Population studies Prediabetic State - blood Prediabetic State - diagnosis Prediabetic State - epidemiology Prediabetic State - physiopathology Prevalence Prognosis Prospective Studies Regression analysis Retina Risk Assessment Risk Factors Sex Sex difference Sex differences Sex Factors Statistical analysis Type 2 diabetes Women Womens health |
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| Title | Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study |
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