Survival Has Improved in Men but not Women with Diabetes
Improvements in the care and treatment of diabetes and heart disease in the last 30 years have led to better survival in diabetic men, but diabetic women seem to have been left behind. Not only has survival not gotten better in women with diabetes, the mortality gap between diabetic women and their non-diabetic counterparts has actually gotten bigger, according to a study published August 7, 2007 in Annals of Internal Medicine.
The study, conducted by researchers from the Centers for Disease Control and Prevention, looked at data from 3 nationwide surveys conducted between 1971 and 1994 of more than 26,000 adults. Survey respondents were asked whether or not they had diabetes, then followed for 12 years to see who was still living and who had died. In all, 2059 patients had diabetes (58% were women).
Deaths due to heart disease declined over the 30 years of the study in men with diabetes (from 26.4 to 12.8 deaths each year per 1000 people), in men without diabetes (from 9.6 to 4.7 deaths each year per 1000 people), and in women without diabetes (from 4.7 to 2.3 deaths each year per 1000 people). However, women with diabetes saw no improvement: their heart disease death rate stayed about the same.
Also troubling is the fact that while the mortality gap between men with and without diabetes has gotten smaller over the years, in women it more than doubled (from a difference of 8.3 to 18.2 yearly deaths per 1000 people). This means that women with diabetes are even more likely to die compared to women without diabetes than they were 30 years ago.
In an accompanying editorial, Nanette Wenger, MD of the Emory School of Medicine suggests that the lack of improvement in women with diabetes may be because women with diabetes and heart disease are less likely to receive proper care. For example, she cites studies that show that diabetic women are less likely to have their cholesterol under control, receive fewer heart disease prevention therapies, and wait longer to have their heart disease diagnosed compared with men.
Dr. Wenger concludes that improved access to care in women with diabetes and more aggressive control of CAD risk factors are the only ways to improve survival in these extremely vulnerable women. Further studies are needed to find out how to bring about these changes and make sure that women as well as men benefit from advances in heart disease treatment and prevention.
Gregg EW, Gu Q, Cheng TJ, et al. Mortality trends in men and women with diabetes, 1971 to 2000. Ann Intern Med. 2007;147:149-155.
Wenger, NK. Heightened cardiovascular risk in diabetic women: can the tide be turned? Ann Intern Med. 2007;147:208-210.