Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program

01 March 2023


Lee-Ling Lim, Eric SH Lau, Alice PS Kong, Amy WC Fu, Vanessa Lau, Weiping Jia, Wayne HH Sheu, Leorino Sobrepena, KH Yoon, Alexander TB Tan, Yook-Chin Chia, Aravind Sosale, Banshi D Saboo, Jothydev Kesavadev, Su-Yen Goh, Thy Khue Nguyen, Yotsapon Thewjitcharoen, Raymond Suwita, Ronald CW Ma, Elaine YK Chow, Andrea OY Luk, and Juliana CN Chan

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Abstract

Background

In Asia, diabetes-associated death due to cardiorenal diseases were 2–3 times higher in women than men which might be due to gender disparity in quality of care and health habits.

Methods

Adults with type 2 diabetes (T2D) from 11 Asian countries/areas were assessed using the same protocol (2007–2015). We compared treatment target attainment (HbA1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-based LDL-cholesterol, lack of central obesity [waist circumference <90 cm in men or <80 cm in women), use of cardiorenal-protective drugs (renin-angiotensin system [RAS] inhibitors, statins), and self-reported health habits including self-monitoring blood glucose (SMBG) by gender. Analyses were stratified by countries/areas, age of natural menopause (<50 vs. ≥50 years), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney impairment [eGFR < 60 mL/min/1.73 m2]).

Findings

Among 106,376 patients (53.2% men; median (interquartile range) diabetes duration: 6.0 (2.0–12.0) years; mean ± SD HbA1c 8.0 ± 1.9%; 27% insulin-treated), women were older and less likely to receive college education than men (28.9% vs. 48.8%). Women were less likely to smoke/drink alcohol and were physically less active than men. Women had lower BP (<130/80 mmHg: 29.4% vs. 25.7%), less general obesity (54.8% vs. 57.8%) but more central obesity than men (77.5% vs. 57.3%). Women were less likely to have ASCVD (12.8% vs. 17.0%) or heart failure (1.3% vs. 2.3%), but more likely to have kidney impairment (22.3% vs. 17.6%) and any-site cancer than men (2.5% vs. 1.6%). In most countries/areas, more men attained HbA1c <7% and risk-based LDL-cholesterol level than women. After adjusting for potential confounders including countries and centres, men had 1.63 odds ratio (95% CI 1.51, 1.74) of attaining ≥3 treatment targets than women.

Interpretation

Asian women with T2D had worse quality of care than men especially in middle-income countries/areas, calling for targeted implementation programs to close these care gaps.

Sponsor

Asia Diabetes Foundation.

Reference

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Cite

Lim LL, Lau ESH, Kong APS, Fu AWC, Lau V, Jia W, Sheu WHH, Sobrepena L, Yoon KH, Tan ATB, Chia YC, Sosale A, Saboo BD, Kesavadev J, Goh SY, Nguyen TK, Thewjitcharoen Y, Suwita R, Ma RCW, Chow EYK, Luk AOY, Chan JCN. Gender-associated cardiometabolic risk profiles and health behaviors in patients with type 2 diabetes: a cross-sectional analysis of the Joint Asia Diabetes Evaluation (JADE) program. Lancet Reg Health West Pac. 2022 Dec 19;32:100663. doi: 10.1016/j.lanwpc.2022.100663.

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