Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes.

OBJECTIVE: Disparities in outcomes for cardiovascular disease (CVD) exist between men and women with type 2 diabetes mellitus (T2DM). We examined gender differences in composite control of cardiovascular risk factors in a sample of adults with T2DM. SUBJECTS AND METHODS: This was a cross-sectional study of 680 people recruited from three primary care settings. Primary outcomes were individual and composite control of CVD risk factors. Control of individual risk outcomes was defined as glycosylated hemoglobin A1c (HbA1c) level of <7%, blood pressure (BP) of <130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol level of <100 mg/dL. Composite control was defined as having all three outcomes under control simultaneously. Linear and logistic regression models were used to assess differences in individual means and individual and composite outcomes control between men and women, while adjusting for relevant covariates. RESULTS: Men made up 56% of the sample, approximately 67% were non-Hispanic black, and 78% made less than $35,000 annually. Unadjusted mean systolic BP (134 mm Hg vs. 130 mm Hg, P=0.005) and LDL cholesterol (99.7 mg/dL vs. 87.6 mg/dL, P<0.001) levels were significantly higher in women than in men. Adjusted linear regression showed mean diastolic BP (ß=3.09; 95% confidence interval 0.56, 5.63) was significantly higher in women. Overall, 12.4% of the sample had composite control, and women had poorer composite control compared with men (5.9% vs. 17.3%). Adjusted logistic models showed that men were significantly more likely to have composite risk factor control (odds ratio 2.90; 95% confidence interval 1.37, 6.13) compared with women. CONCLUSIONS: In this sample of adults with T2DM, women had significantly lower composite control compared with men, when adjusting for relevant confounders. It is imperative that women are informed about CVD risk factors, educated on how to reduce them, and aggressively treated to avoid adverse outcomes. Additional research involving women is needed to explore and reduce disparities in CVD risk between men and women with T2DM.

Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review.

Social determinants of health include the social and economic conditions that influence health status. Research into the impact of social determinants on individuals with type 2 diabetes has largely focused on the prevention of or risk of developing diabetes. No review exists summarizing the impact of social determinants of health outcomes in patients with type 2 diabetes. This systematic review examined whether social determinants of health have an impact on health outcomes in type 2 diabetes. Medline was searched for articles that (a) were published in English (b) targeted adults, ages 18 + years, (c) had a study population which was diagnosed with type 2 diabetes, (d) the study was done in the United States, and (e) the study measured at least one of the outcome measures-glycemic control, cholesterol (LDL), blood pressure, quality of life or cost. Using a reproducible strategy, 2,110 articles were identified, and 61 were reviewed based on inclusion criteria. Twelve were categorized as Economic Stability and Education, 17 were categorized as Social and Community Context, 28 were categorized as Health and Health Care, and three were categorized as Neighborhood and Built Environment. Based on the studies reviewed, social determinants have an impact on glycemic control, LDL, and blood pressure to varying degrees. The impact on cost and quality of life was not often measured, but when quality of life was investigated, it did show significance. More research is needed to better characterize the direct impact of social determinants of health on health outcomes in diabetes.