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Comparative Study
. 2024 Sep 16;23(1):342.
doi: 10.1186/s12933-024-02419-4.

Sex inequalities in cardiovascular risk factors and their management in primary prevention in adults living with type 1 diabetes in Germany and France: findings from DPV and SFDT1

Emmanuel Cosson  1   2 , Marie Auzanneau  3   4 , Gloria A Aguayo  5 , Wolfram Karges  6 , Jean-Pierre Riveline  7   8 , Petra Augstein  9 , Laura Sablone  10 , Peter Jehle  11 , Guy Fagherazzi  5 , Reinhard W Holl  3   4 ; DPV initiative and the SFDT1 study group
Affiliations
Comparative Study

Sex inequalities in cardiovascular risk factors and their management in primary prevention in adults living with type 1 diabetes in Germany and France: findings from DPV and SFDT1

Emmanuel Cosson et al. Cardiovasc Diabetol. .

Abstract

Introduction & objectives: To evaluate whether cardiovascular risk factors and their management differ in primary prevention between adult males and females with type 1 diabetes (T1D) in two European countries in 2020-2022 and sex inequalities in achievement of standards of care in diabetes.

Methods: We used 2020-2022 data of patients without a cardiovascular history in the Prospective Diabetes Follow-up registry (DPV) centres, in Germany, and the Société Francophone du Diabète- Cohorte Diabète de Type 1 cohort (SFDT1), in France.

Results: We included 2,657 participants from the DPV registry and 1,172 from the SFDT1 study. Body mass indexes were similar in females and males with similar proportions of HbA1c < 7% (DPV: 36.6 vs 33.0%, p = 0.06, respectively; SFDT1: 23.4 vs 25.7%, p = 0.41). Females were less overweight compared to men in DPV (55.4 vs 61.0%, p < 0.01) but not in SFDT1 (48.0 vs 44.9%, p = 0.33) and were less prone to smoke (DPV: 19.7 vs 25.8%, p < 0.01; SFDT1: 21.0 vs 26.0%, p = 0.07). Systolic blood pressure was lower in females than males with a higher rate of antihypertensive therapy in case of hypertension in females in DPV (70.5 vs 63.7%, p = 0.02) but not in SFDT1 (73.3 vs 68.6%, p = 0.64). In the case of microalbuminuria, ACEi-ARB were less often prescribed in women than men in DPV (21.4 vs 37.6%, p < 0.01) but not SFDT1 (73.3 vs 67.5.0%, p = 0.43). In females compared to males, HDL-cholesterol levels were higher; triglycerides were lower in both countries. In those with LDL-cholesterol > 3.4 mmol/L (DPV: 19.9 (females) vs 23.9% (males), p = 0.01; SFDT1 17.0 vs 19.2%, p = 0.43), statin therapy was less often prescribed in females than males in DPV (7.9 vs 17.0%, p < 0.01), SFDT1 (18.2 vs 21.0%, p = 0.42).

Conclusion: In both studies, females in primary prevention have a better cardiovascular risk profile than males. We observed a high rate of therapeutic inertia, which might be higher in females for statin treatment and nephroprotection with ACEi-ARB, especially in Germany. Diabetologists should be aware of sex-specific differences in the management of cardiorenal risk factors to develop more personalized prevention strategies.

Keywords: Blood pressure; Body mass index; Cardiovascular; Gender; Lipids; Real-world-evidence; Registry; Sex; Smoking; Type 1 diabetes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Achievement of standards of care in diabetes in primary cardiovascular prevention stratified by sex in the DPV (Germany) and the SFDT1 (France) studies. ACEi angiotensin-converting-enzyme inhibitors, ARB angiotensin II receptor blockers, BMI body mass index, DPB diastolic blood pressure, SBP systolic blood pressure; *defined as SBP ≥ 140 mmHg or ≥ 90 mmHg or antihypertensive treatment; **defined as LDL cholesterol ≥ 3.4 mmol/L; ***defined as albuminuria/creatininuria > 3 mg/mmol
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