Poor Outlook for Women Diabetics

Robert W. Griffith, MD

The overall mortality has been falling in the United States for a number of years, but it's not been known, until now, whether it's falling for both diabetics and non-diabetics. Now a study reported in the Annals of Internal Medicine shows pretty clearly that, for men, the rate is falling to about the same degree. But things are different in diabetic women.

The study covers the years 1971 to 2000, using three consecutive groups in the National Health and Nutritional Examination Surveys (NHANES I, II, and III). The participants were between 35 and 74 when examined at baseline. There were 26,000 people in the analysis. About 7% of the men and 9% of the women had diabetes (types I and II combined).

The mortality rate among men with diabetes declined from 42.6 per 1000 in 1971-1986 to 24.4 per 1000 in 1988-2000 - a decline similar to that seen in non-diabetic men, who went from 19.0 per 1000 to 11.6 per 1000 during the same interval. (The mortality rates in diabetic men and women are, of course, higher than in non-diabetics because of the severity of the complications of the disease.)

In diabetic women, there was no such decline in mortality rate over the two periods, whereas non-diabetic women experienced a decline (from 10.1 to 7.7 per 1000).

What's the reason for this gender difference? It's probably related to coronary heart disease (CHD). The declines recorded in men parallel quite closely declines in CHD deaths. CHD is diagnosed at a later stage in women - the presenting symptoms are not quite as typical as those in men. And women may be less likely to receive appropriate care for CHD. The authors of this study, and an editorialist, call for better awareness that diabetic women are at excess risk for developing CHD, and take an aggressive approach to managing the risk factors for CHD; we can all agree with these suggestions.

Source
HealthandAge Blog

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