2型糖尿病患者的性别相关心脏代谢风险特征与健康行为：亚洲糖尿病联合评估（JADE）项目的横断面分析
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.
作者信息
Lim Lee-Ling, Lau Eric S H, Kong Alice P S, Fu Amy W C, Lau Vanessa, Jia Weiping, Sheu Wayne H H, Sobrepena Leorino, Yoon K H, Tan Alexander T B, Chia Yook-Chin, Sosale Aravind, Saboo Banshi D, Kesavadev Jothydev, Goh Su-Yen, Nguyen Thy Khue, Thewjitcharoen Yotsapon, Suwita Raymond, Ma Ronald C W, Chow Elaine Y K, Luk Andrea O Y, Chan Juliana C N
机构信息
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
出版信息
Lancet Reg Health West Pac. 2022 Dec 19;32:100663. doi: 10.1016/j.lanwpc.2022.100663. eCollection 2023 Mar.
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 < 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 ≥50 years), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], heart failure, kidney impairment [eGFR < 60 mL/min/1.73 m]).
FINDINGS
Among 106,376 patients (53.2% men; median (interquartile range) diabetes duration: 6.0 (2.0-12.0) years; mean ± SD HbA 8.0 ± 1.9%; 27% insulin-treated), women were older and less likely to receive college education than men (28.9% 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% 25.7%), less general obesity (54.8% 57.8%) but more central obesity than men (77.5% 57.3%). Women were less likely to have ASCVD (12.8% 17.0%) or heart failure (1.3% 2.3%), but more likely to have kidney impairment (22.3% 17.6%) and any-site cancer than men (2.5% 1.6%). In most countries/areas, more men attained HbA <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.
SPONSOR
Asia Diabetes Foundation.
FUNDING
Nil.
背景
在亚洲，女性因心肾疾病导致的糖尿病相关死亡人数比男性高2至3倍，这可能是由于护理质量和健康习惯方面的性别差异所致。
方法
采用相同方案（2007 - 2015年）对来自11个亚洲国家/地区的成年2型糖尿病（T2D）患者进行评估。我们比较了治疗目标达成情况（糖化血红蛋白<7%、血压[BP]<130/80 mmHg、基于风险的低密度脂蛋白胆固醇、无中心性肥胖[男性腰围<90 cm或女性腰围<80 cm]）、心肾保护药物（肾素 - 血管紧张素系统[RAS]抑制剂、他汀类药物）的使用情况以及自我报告的健康习惯，包括按性别划分的自我血糖监测（SMBG）。分析按国家/地区、自然绝经年龄（<50岁与≥50岁）以及合并症（动脉粥样硬化性心血管疾病[ASCVD]、心力衰竭、肾功能损害[eGFR<60 mL/min/1.73 m²]）进行分层。
研究结果
在106376例患者中（53.2%为男性；糖尿病病程中位数（四分位间距）：6.0（2.0 - 12.0）年；糖化血红蛋白均值±标准差8.0±1.9%；27%接受胰岛素治疗），女性比男性年龄更大，接受大学教育的可能性更低（分别为28.9%和48.8%）。女性吸烟/饮酒的可能性较低，身体活动也比男性少。女性血压较低（<130/80 mmHg：29.4%与25.7%），总体肥胖较少（54.8%与57.8%），但中心性肥胖比男性更多（77.5%与57.3%）。女性患ASCVD（12.8%与17.0%）或心力衰竭（1.3%与2.3%）的可能性较小，但患肾功能损害（22.3%与17.6%）和任何部位癌症的可能性比男性更高（2.5%与1.6%）。在大多数国家/地区，达到糖化血红蛋白<7%和基于风险的低密度脂蛋白胆固醇水平的男性比女性更多。在调整包括国家和中心等潜在混杂因素后，男性达到≥3个治疗目标的优势比为1.63（95%CI 1.51，1.74），高于女性。
解读
亚洲T2D女性的护理质量比男性差，尤其是在中等收入国家/地区，需要有针对性的实施计划来缩小这些护理差距。
资助者
亚洲糖尿病基金会。资金来源：无。
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