Tailored health goals reduce mortality in women, not men, with type 2 diabetes

Women with type 2 diabetes randomly assigned to personally tailored health care goals had reduced diabetes-related and all-cause mortality at follow-up, whereas men did not benefit from such treatment, according to research in Diabetologia.

In post-hoc analysis of a 6-year randomized controlled trial of men and women with diabetes randomly assigned to structured personal care or routine care, researchers found that, 13 years after study completion, women assigned to structured care were 26% less likely to die of any cause and 30% less likely to die of a diabetes-related cause vs. women assigned routine care.

“With our gender-based results showing improved morbidity and mortality outcomes for women receiving structured personal care, but without any obvious explanation from improved intermediate outcomes (except for HbA1c, for which we adjust), we need to discuss how gender really matters in diabetes and diabetes care,” Marlene Ø. Krag, MD, MIH, of the research unit for general practice in the department of public health at the University of Copenhagen, Denmark, and colleagues wrote.

Krag and colleagues analyzed data from 970 surviving adults with type 2 diabetes (478 women) who participated the Diabetes Care in General Practice study, conducted between 1989 and 1995 in Denmark. Primary care providers in the study’s intervention group were encouraged to recommend increased physical activity, stress simple dietary rules and postpone prescribing glucose-lowering drugs until at least 3 months after a diabetes diagnosis, when possible. Providers in the usual care group were free to choose any treatment and change it over time if necessary.

After 6 years, women assigned to the structured care saw greater improvements in HbA1c (8.6% vs. 9.4%) vs. men assigned to structured care (8.8% vs. 9%), but researchers observed no other gender-specific differences.

During 13 years of follow-up, researchers did not observe a statistically significant reduction in outcomes for men in the structured care group. However, women assigned to structured care saw a significant reduction in absolute risk for any diabetes-related endpoint after adjustment for multiple factors (HR = 0.65; 95% CI, 0.48-0.87), as well as a reduction in risk for diabetes-related death (HR = 0.7; 95% CI, 0.5-0.96), all-cause mortality (HR = 0.74; 95% CI, 0.57-0.97) and stroke (HR = 0.59; 95% CI, 0.36-0.97). Differences between women and men were statistically significant only for all-cause mortality and diabetes-related death, according to researchers. – by Regina Schaffer

The researchers report no relevant financial disclosures.

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