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Type 1 diabetes in women, a systematic review and meta-analysis. 26 studies and 214 114 individuals. TIME TO ACT. The Lancet.

Type 1 Diabetes More Deadly for Women Than Men, Study Finds

Better treatment and support needed for both sexes and even more for women

 

THURSDAY, Feb. 5, 2015 (HealthDay News) — Women with type 1 diabetes have a nearly 40 percent greater risk of dying from any cause and more than double the risk of dying from heart disease than men with type 1 diabetes, Australian researchers report.

 

In an analysis of 26 studies that included more than 200,000 people, researchers found that women with type 1 diabetes had a 37 percent higher risk of dying from stroke compared to men with type 1 diabetes. The researchers also found that women with type 1 diabetes had a 44 percent greater risk of dying from kidney disease than men with type 1 diabetes.

 

”Type 1 diabetes increases the risk of premature death in both women and men, but type 1 diabetes is much more deadly for women than men with the condition,” said lead researcher Rachel Huxley, director of the Queensland Clinical Trials and Biostatistics Center at the University of Queensland in Herston, Australia.

The report was published in the Feb. 6 online edition of The Lancet Diabetes & Endocrinology.

 

Type 1 diabetes an autoimmune disease that destroys insulin-producing cells in the pancreas. Insulin is a hormone needed to convert sugars, starches and other foods into energy. The worldwide incidence of type 1 diabetes in children 14 and younger has risen by 3 percent every year since 1989.

 

However, insulin needs change constantly, depending on foods eaten, activity levels and even stress. This makes it difficult to get the dose just right. When too little insulin is given, blood sugar levels rise. Over time, this can cause dangerous complications, such as an increased risk of heart disease.

 

But, too much insulin can cause low blood sugar levels (hypoglycemia), which can quickly cause a number of uncomfortable symptoms, such as sweating, nausea, irritability and confusion. Left untreated, hypoglycemia can lead to unconsciousness and even death, according to JDRF (formerly the Juvenile Diabetes Research Foundation).

 

Women may have a harder time controlling blood sugar levels due to a number of factors, such as changing hormone levels — particularly during puberty — that can affect the body’s sensitivity to insulin and cause fluctuations in blood sugar levels, according to Huxley and her co-authors.

 

The researchers also speculated that high levels of blood sugar may cause more damage to women’s blood vessels than to men’s.

 

”The findings suggest that young girls and women with type 1 diabetes may need additional monitoring, not only to ensure that they are keeping their blood sugar levels under control, but also to make sure that their levels for other major risk factors, such as blood pressure and lipids, are also closely monitored,” she said.

 

”As soon as an individual is diagnosed with type 1 diabetes — irrespective of sex — they should receive greater support and assistance in managing their health and risk factor levels for heart disease and stroke,” Huxley added.

 

Dr. David Simmons, a professor of medicine at the University of Western Sydney in Penrith, Australia, and author of an accompanying journal editorial, said, ”Among people without diabetes, women live longer than men. This advantage is being lost among women with type 1 diabetes. Both women and men with type 1 diabetes are dying much younger than they should.”

 

Simmons said he doesn’t know why this disparity exists, but it appears that excess sugar may cause more harm to women’s blood vessels than to men’s. ”There may be a need to treat women earlier with drugs to prevent heart disease and stroke,” he said.

 

He doesn’t think blood sugar control is worse in women than it is in men. However, everyone with type 1 diabetes needs better ways of controlling blood sugar to prevent episodes of hypoglycemia and hyperglycemia. Insulin pumps and continuous glucose monotoring (CGM) should be used even more today than it is used. Hypoglycemia can be life-threatening and take a toll on overall health, especially in patients with 30-40 years of diabetes or more with problems with hypoglycemia unawareness, he said.

 

”Much of the excess death among men and women is preventable with better access to methods of controlling blood sugar, such as insulin pumps and CGM,” Simmons said. ”But we still need to research why these early deaths are happening.”

 

More information

 

For more on type 1 diabetes, visit the American Diabetes Association.

SOURCES: Rachel Huxley, Ph.D., director, Queensland Clinical Trials and Biostatistics Center, University of Queensland, Herston, Australia; David Simmons,M.D., professor of medicine, University of Western Sydney,Penrith, Australia; Feb. 6, 2015, The Lancet Diabetes & Endocrinology, online

 

From http://consumer.healthday.com

 

ABSTRACT

 

Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis

 

Prof Rachel R Huxley, DPhil

Sanne A E Peters, PhD

 

Prof Gita D Mishra, PhD

Prof Mark Woodward, PhD

Published Online: 05 February 2015

 

DOI: http://dx.doi.org/10.1016/S2213-8587(14)70248-7

 

Background

Studies have suggested sex differences in the mortality rate associated with type 1 diabetes. We did a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes.

 

Methods

We systematically searched PubMed for studies published between Jan 1, 1966, and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. We used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes.

 

 

Findings

Data from 26 studies including 214 114 individuals and 15 273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·37 (95% CI 1·21–1·56), for incident stroke 1·37 (1·03–1·81), for fatal renal disease 1·44 (1·02–2·05), and for fatal cardiovascular diseases 1·86 (1·62–2·15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2·54 (95% CI 1·80–3·60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide.

 

Interpretation

Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes.

 

Funding

None.

Editorial

Excess deaths in women with type 1 diabetes: TIME TO ACT.

Dr David Simmons, of the Wolfson Diabetes and Endocrinology Clinic, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, United Kingdom, writes, and rightly suggest ”that the sex difference in excess mortality in those with type 1 diabetes should stimulate some kind of action.”

 

However, Dr Simmons says, ”This action should not be sex based: health and funding systems should systematically support improvements in glycemic control from diagnosis, for all patients with type 1 diabetes, through tailored insulin therapy, insulin pumps and CGM, including mental-health support and personalized strategies that help avoid hypoglycemia.

 

Sex differences in management of cardiovascular disease and its risk factors also need to be rectified.”

 

The gender imbalance may be due to worse glycemic control among females compared with males, but studies on this have mostly been conducted in youth with type 1 diabetes, and the data have been conflicting.

 

”This is still a very controversial area, and there are very few data on these issues — hopefully, this paper will prompt future studies to look really closely at how women and men with the condition differ,” Dr Huxley said.

 

 

Fler kvinnor med diabetes dör i förtid

En ny studie visar att kvinnor med typ 1-diabetes löper dubbelt så stor risk att dö av hjärtkärlsjukdomar, jämfört med diabetessjuka män.

 

Studien är publicerad i den vetenskapliga tidskriften The Lancet och innefattar drygt 214 000 personer från olika delar av världen.

 

Forskarna undersökte risken att drabbas av problem med hjärtat eller njurar till följd av typ 1-diabetes, och fann att kvinnor har dubblerad risk att dö i förtid av hjärtkärlsjukdom. Detta jämfört med diabetessjuka män.

Att kvinnor har sämre blodsockerkontroll kan vara en orsak, något som redan visar sig i tonåren.


– Det här kan bero bland annat på att kvinnor saknar det stöd som männen ofta får hemifrån och kvinnorna har ett större behov av stöd ifrån sjukvården också, säger Kerstin Brismar som är professor i diabetesforskning vid Karolinska institutet, till SVT.


Hon tror däremot inte att kvinnor får sämre diabetesvård än män.

– Nej, det har vi inte kunnat se, däremot har studier visat att kvinnor ett större behov av kontakt med läkare och sjuksköterskor och det kan bero på att kvinnor fokuserar mer på sina familjer istället för att prioritera sin egen hälsa.

En annan förklaring till kvinnors förhöjda risk kan bottna i hormonet östrogen som har en skyddande effekt vid hjärtkärlsjukdom. Under de fertila åren går östrogenproduktionen ned vilket innebär att kvinnor med typ 1-diabetes kan hamna i klimakteriet upp till tio år tidigare, jämfört med dem som inte har sjukdomen.


– När östrogennivåerna minskar så stiger det farliga kolesterolet, ämnesomsättningen förändras och vi får en större fettmassa och bukfett. Allt det ökar risken för hjärtkärlsjukdom, säger Kerstin Brismar till SVT.

Hon påpekar att kvinnor med typ 1-diabetes kan kontakta en gynekolog för att undersöka nivån av östrogen.


– Mitt råd är att söka hjälp inom sjukvården så att kvinnor med typ 1 diabetes  får en så bra och jämn blodsockerkontroll som möjligt med de olika hjälpmedel som finns – och så ska man ha kontakt med gynekolog och testa om man har för lite östrogen. Då kan man fundera på om man ska ta östrogentillskott eller inte.

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