Arnetz Lisa, Ekberg Neda Rajamand, Alvarsson Michael
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ; Department of Endocrinology, Metabolism and Diabetes, Stockholm, Sweden.
Diabetes Metab Syndr Obes. 2014 Sep 16;7:409-20. doi: 10.2147/DMSO.S51301. eCollection 2014.
Women with type 2 diabetes (T2D) are less likely to reach the goals for hemoglobin A1c compared with men, and have higher all-cause mortality. The risk of cardiovascular disease is elevated among both men and women with T2D, however, the risk has declined among men over recent years while it remains stationary in women. Reasons for these sex differences remain unclear, and guidelines for diabetes treatment do not differentiate between sexes. Possible causes for varying outcome include differences in physiology, treatment response, and psychological factors. This review briefly outlines sex differences in hormonal pathophysiology, and thereafter summarizes the literature to date on sex differences in disease course and outcome.
Systematic searches were performed on PubMed using "sex", "gender", and various glucose-lowering therapies as keywords. Earlier reviews are summarized and results from individual studies are reported. Reference lists from studies were used to augment the search.
There is an increased risk of missing the diagnosis of T2D when screening women with only fasting plasma glucose instead of with an oral glucose tolerance test. The impact of various risk factors for complications may differ by sex. Efficacy and side effects of some glucose-lowering drugs differ between men and women. Men with T2D appear to suffer more microvascular complications, while women have higher morbidity and mortality in cardiovascular disease and also fare worse psychologically.
Few studies to date have focused on sex differences in T2D. Several questions demand further study, such as whether risk factors and treatment guidelines should be sex-specific. There is a need for clinical trials designed specifically to evaluate sex differences in efficacy and outcome of the available treatments.
与男性相比，2型糖尿病（T2D）女性患者更难达到糖化血红蛋白目标，且全因死亡率更高。T2D男性和女性患心血管疾病的风险均有所升高，然而，近年来男性的风险有所下降，而女性的风险保持稳定。这些性别差异的原因尚不清楚，糖尿病治疗指南也未区分性别。结果差异的可能原因包括生理、治疗反应和心理因素的不同。本综述简要概述了激素病理生理学中的性别差异，然后总结了迄今为止关于疾病进程和结果中性别差异的文献。
在PubMed上进行系统检索，使用“性别”“社会性别”以及各种降糖疗法作为关键词。总结早期综述并报告个体研究结果。利用研究的参考文献列表来扩大检索范围。
仅用空腹血糖而非口服葡萄糖耐量试验筛查女性时，漏诊T2D的风险增加。各种并发症风险因素的影响可能因性别而异。一些降糖药物的疗效和副作用在男性和女性之间有所不同。T2D男性似乎更容易出现微血管并发症，而女性在心血管疾病方面的发病率和死亡率更高，心理状况也更差。
迄今为止，很少有研究关注T2D中的性别差异。几个问题需要进一步研究，例如风险因素和治疗指南是否应针对性别制定。需要专门设计临床试验来评估现有治疗方法在疗效和结果方面的性别差异。
