Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
The George Institute for Global Health, Imperial College London, London, United Kingdom.
Front Endocrinol (Lausanne). 2021 Mar 30;12:617902. doi: 10.3389/fendo.2021.617902. eCollection 2021.
Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.
PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.
Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.
Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.
深入了解心血管风险因素检测和糖尿病相关并发症方面的性别差异，可能会改善糖尿病的护理。本系统评价的目的是研究在评估心血管风险因素和筛查糖尿病相关并发症方面是否存在性别差异。
系统检索了 PubMed 数据库，检索时间截至 2020 年 4 月，随后使用 Google Scholar 进行手动参考文献筛查和引文检查（滚雪球法）。如果研究报告了男性和女性糖尿病患者的心血管风险因素（HbA1c、血脂、血压、吸烟状况或 BMI）评估和/或肾病、视网膜病变或足部检查筛查情况，则将其纳入本研究。纳入了对至少年龄进行调整或考虑年龄为协变量但由于各种原因（即向后选择）未纳入最终分析的研究进行定性分析。由于预计研究之间存在很大的异质性，因此未计划进行荟萃分析。使用改良的 Newcastle-Ottawa 质量评估量表对队列研究进行了偏倚风险评估。
共纳入 81 项研究。大多数纳入的研究来自欧洲或北美（84%）。每项研究的个体数量从 200 到 3135019 不等，数据来自各种来源，在各种环境下提取。筛查率在不同研究之间差异很大。例如，视网膜病变的筛查率从 13%到 90%不等，有一半的研究报告的筛查率低于 50%。关于评估心血管风险因素和筛查糖尿病相关并发症方面性别差异的存在、程度和方向，存在混杂的研究结果，有证据表明，与男性相比，女性可能更有可能接受视网膜病变筛查，而不太可能接受足部检查。
总体而言，在评估心血管风险因素和筛查糖尿病相关并发症方面，没有发现有利于男性或女性的一致模式，并且可以提高两性的筛查率。
