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Does women's health deteriorate more rapidly than that of men prior to the onset of type 2 diabetes?

Diabetologia

New research presented at this year's annual meeting of the European Association for the Study of Diabetes (EASD) reveals that prior to the onset of type 2 diabetes (T2D), women with versus without prediabetes experience significantly larger adverse differences in their cardiometabolic health than men.

The research was conducted by Rianneke de Ritter and colleagues from the Department of Internal Medicine, Maastricht University Medical Centre, together with other researchers from Maastricht University, Maastricht, Netherlands and The George Institute for Global Health, University of Oxford, Oxford, UK. The aim of the study was to evaluate sex-related differences in cardiovascular risk factor levels, both before and after the onset of T2D.

T2D is known to reduce or even reverse the protective effect of being female on the risk of developing cardiovascular disease, however the mechanisms responsible for these sex differences remain a mystery. The metabolic changes that eventually lead to T2D can precede the development of hyperglycaemia (caused by poorly controlled blood glucose levels) by years or even decades. Despite this, there has been little investigation into whether women suffer a relatively worse cardiometabolic risk profile before developing the disease.

The authors analysed a population-based cohort of individuals aged 40-75 years, The Maastricht Study, containing an elevated number of people with T2D to investigate differences in the levels of cardiovascular risk factors between prediabetes and T2D on the one hand, and normal glucose metabolism on the other. Analyses were performed which adjusted for the age and sex of subjects, and, where appropriate, their medication use, to determine whether this difference was dissimilar in men and women.

The study found that when comparing individuals with prediabetes to healthy subjects with normal glucose metabolism, the size of the difference in a number of cardiometabolic risk markers was greater in women than in men. Women with prediabetes had a more elevated blood pressure, a more adverse difference in HDL (good) and LDL (bad) cholesterol, and more elevated levels of triglycerides (a type of fat) and markers of inflammation in the blood than prediabetic men.

The authors state: "The novel finding of this study is that there are already sex differences in cardiometabolic risk factors before the onset of T2D, to women's disadvantage."

They add: "Sex differences in some, not all, of the cardiometabolic risk factors, which were less favourable for the female sex (in individuals with T2D), were also observed in their association with prediabetes. This suggests that the cardiometabolic risk profile of women has deteriorated to a larger extent even before the onset of T2D, which needs to be confirmed by prospective studies."

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