Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study

• Published in: Cardiovascular diabetology Vol. 20; no. 1; pp. 102 - 15
• Main Authors: de Ritter, Rianneke, Sep, Simone J. S., van der Kallen, Carla J. H., van Greevenbroek, Marleen M. J., de Jong, Marit, Vos, Rimke C., Bots, Michiel L., Reulen, Jos P. H., Houben, Alfons J. H. M., Webers, Carroll A. B., Berendschot, Tos T. J. M., Dagnelie, Pieter C., Eussen, Simone J. P. M., Schram, Miranda T., Koster, Annemarie, Peters, Sanne A. E., Stehouwer, Coen D. A.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 07.05.2021; BMC
• Subjects: 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; Netherlands; Type 2 diabetes; Women; Nephropathy; Retinopathy; Sex; Neuropathy; Microvascular complications; Epidemiology; Sex difference
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-021-01290-x

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.