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

Authors

Lee-Ling Lim
Eric S H Lau
Alice P S Kong
Amy W C Fu
Vanessa Lau
Weiping Jia
Wayne H H Sheu
Leorino Sobrepena
K H Yoon
Alexander T B Tan
Yook-Chin Chia
Aravind Sosale
Banshi D Saboo
Jothydev Kesavadev
Su-Yen Goh
Thy Khue Nguyen
Yotsapon Thewjitcharoen
Raymond Suwita
Ronald C W Ma
Elaine Y K Chow
Andrea O Y Luk
Juliana C N Chan

Publication Date

3-1-2023

Journal

The Lancet Regional Health – Western Pacific

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 (HbA_1c < 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 HbA_1c 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 HbA_1c <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.

Keywords

Disparity, Care gaps, Inequality, Ethnicity, Type 2 diabetes, Treatment targets, Cardiovascular risk factors, Comorbidity, Self-management