Do Women With Type-1 Diabetes Have Higher Mortality Risk Than Men?

Women with type-1 diabetes have a 37 percent greater excess risk of all-cause mortality than men, according to a study published Feb. 5 in The Lancet: Diabetes & Endocrinology.

Researchers analyzed 26 different studies from PubMed that included information on all-cause or cause-specific mortality for both men and women with type-1 diabetes, in order to examine if sex differences were present in the risk of mortality from the condition. The data set included 214,114 individuals and 15,273 cause-specific mortality events, including those from cardiovascular disease, stroke, and coronary heart disease (CHD).

Results from the meta-study reported a combined standardized mortality ratio for all-cause mortality in patients with type-1 diabetes was 5.8 in women – compared to 3.8 in men – indicating an overall greater excess risk of all-cause mortality of 37 percent. Further, researchers found that, compared to men with type-1 diabetes, women with the condition had twice the excess risk of fatal and nonfatal vascular events. Specifically the excess event rate of CHD in women was 154 percent greater than that in men, and 37 percent greater in the excess event rate of stroke. Researchers associate the higher vascular mortality rates in women with an overall higher lifetime exposure to hyperglycemia, as women were shown to have poorer glycemic control in previous studies.

The authors of the study note that “ultimately, an increased understanding and appreciation of sex differences in the effect of type-1 diabetes on vascular-related disease is likely to have profound clinical implications for how women with type-1 diabetes are treated and managed throughout their life course.”

An editorial comment by David Simmons, University of Western Sydney, Australia, adds that “a key question is how the risk of excess mortality in women can be reduced further – a particular challenge given that the reasons for excess mortality in type 1 diabetes are still unclear.” He adds that moving forward, “achievement of a reduction in the high type 1 diabetes mortality rates will need additional expenditure on the care of patients with the disorder, many of the benefits from which might not be seen for up to 20 years. The additional investment in the services and equipment to improve glycaemic control must start now.”

Keywords: Achievement, Australia, Coronary Disease, Diabetes Mellitus, Type 1, Health Expenditures, Hyperglycemia, PubMed, Research Personnel, Sex Characteristics, Stroke

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