Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study

Rianneke de Ritter; Simone J.S. Sep; Carla J.H. van der Kallen; Marleen M.J. van Greevenbroek; Marit de Jong; Rimke C. Vos; Michiel L. Bots; Jos P.H. Reulen; Alfons J.H.M. Houben; Carroll A.B. Webers; Tos T.J.M. Berendschot; Pieter C. Dagnelie; Simone J.P.M. Eussen; Miranda T. Schram; Annemarie Koster; Sanne A.E. Peters; Coen D.A. Stehouwer

doi:10.1186/s12933-021-01290-x

Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study

Rianneke de Ritter (Corresponding author)
, Simone J.S. Sep
, Carla J.H. van der Kallen
, Marleen M.J. van Greevenbroek
, Marit de Jong
, Rimke C. Vos
, Michiel L. Bots
, Jos P.H. Reulen
, Alfons J.H.M. Houben
, Carroll A.B. Webers
, Tos T.J.M. Berendschot
, Pieter C. Dagnelie
, Simone J.P.M. Eussen
, Miranda T. Schram
, Annemarie Koster
, Sanne A.E. Peters
, Coen D.A. Stehouwer

Medical Image Analysis

Research output: Contribution to journal › Article › Academic › peer-review

41 Citations (Scopus)

83 Downloads (Pure)

Abstract

Background
Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures.

Methods
In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders.

Results
Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation.

Conclusions
Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.

Original language	English
Article number	102
Number of pages	15
Journal	Cardiovascular Diabetology
Volume	20
DOIs	https://doi.org/10.1186/s12933-021-01290-x
Publication status	Published - 7 May 2021

Funding

Health Foundation Limburg Acronym: HFL

Funders	Funder number
ZonMw : Dutch Organisation for Health Research and Development	849200001
Ministerie van Economische Zaken en Klimaat	31O.041
European Regional Development Fund
Care and Public Health Research Institute
Cardiovascular Research Institute Maastricht (CARIM)
Maastricht University Medical Center

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Epidemiology
Type 2 diabetes
Sex
Sex difference
Women
Microvascular complications
Nephropathy
Neuropathy
Retinopathy

Access to Document

10.1186/s12933-021-01290-x

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Cite this

de Ritter, R., Sep, S. J. S., van der Kallen, C. J. H., van Greevenbroek, M. M. J., de Jong, M., Vos, R. C., Bots, M. L., Reulen, J. P. H., Houben, A. J. H. M., Webers, C. A. B., Berendschot, T. T. J. M., Dagnelie, P. C., Eussen, S. J. P. M., Schram, M. T., Koster, A., Peters, S. A. E., & Stehouwer, C. D. A. (2021). Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study. Cardiovascular Diabetology, 20, Article 102. https://doi.org/10.1186/s12933-021-01290-x

@article{faf59ab6ee8c455c88823d65203acfcb,

title = "Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study",

abstract = "Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49\% women, 29\% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95\% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74\% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52\% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.",

keywords = "Epidemiology, Type 2 diabetes, Sex, Sex difference, Women, Microvascular complications, Nephropathy, Neuropathy, Retinopathy",

author = "\{de Ritter\}, Rianneke and Sep, \{Simone J.S.\} and \{van der Kallen\}, \{Carla J.H.\} and \{van Greevenbroek\}, \{Marleen M.J.\} and \{de Jong\}, Marit and Vos, \{Rimke C.\} and Bots, \{Michiel L.\} and Reulen, \{Jos P.H.\} and Houben, \{Alfons J.H.M.\} and Webers, \{Carroll A.B.\} and Berendschot, \{Tos T.J.M.\} and Dagnelie, \{Pieter C.\} and Eussen, \{Simone J.P.M.\} and Schram, \{Miranda T.\} and Annemarie Koster and Peters, \{Sanne A.E.\} and Stehouwer, \{Coen D.A.\}",

year = "2021",

month = may,

day = "7",

doi = "10.1186/s12933-021-01290-x",

language = "English",

volume = "20",

journal = "Cardiovascular Diabetology",

issn = "1475-2840",

publisher = "BioMed Central",

}

de Ritter, R, Sep, SJS, van der Kallen, CJH, van Greevenbroek, MMJ, de Jong, M, Vos, RC, Bots, ML, Reulen, JPH, Houben, AJHM, Webers, CAB, Berendschot, TTJM, Dagnelie, PC, Eussen, SJPM, Schram, MT, Koster, A, Peters, SAE & Stehouwer, CDA 2021, 'Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study', Cardiovascular Diabetology, vol. 20, 102. https://doi.org/10.1186/s12933-021-01290-x

Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study. / de Ritter, Rianneke (Corresponding author); Sep, Simone J.S.; van der Kallen, Carla J.H. et al.
In: Cardiovascular Diabetology, Vol. 20, 102, 07.05.2021.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function

T2 - The Maastricht Study

AU - de Ritter, Rianneke

AU - Sep, Simone J.S.

AU - van der Kallen, Carla J.H.

AU - van Greevenbroek, Marleen M.J.

AU - de Jong, Marit

AU - Vos, Rimke C.

AU - Bots, Michiel L.

AU - Reulen, Jos P.H.

AU - Houben, Alfons J.H.M.

AU - Webers, Carroll A.B.

AU - Berendschot, Tos T.J.M.

AU - Dagnelie, Pieter C.

AU - Eussen, Simone J.P.M.

AU - Schram, Miranda T.

AU - Koster, Annemarie

AU - Peters, Sanne A.E.

AU - Stehouwer, Coen D.A.

PY - 2021/5/7

Y1 - 2021/5/7

N2 - Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.

AB - Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40–75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 µm (1.22;7.36)) and less retinal arteriolar dilatation (difference: − 0.74% (− 1.22; − 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 µm (− 3.50;4.07) and: − 0.52% (− 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications.

KW - Epidemiology

KW - Type 2 diabetes

KW - Sex

KW - Sex difference

KW - Women

KW - Microvascular complications

KW - Nephropathy

KW - Neuropathy

KW - Retinopathy

UR - https://www.scopus.com/pages/publications/85105429198

U2 - 10.1186/s12933-021-01290-x

DO - 10.1186/s12933-021-01290-x

M3 - Article

C2 - 33962619

SN - 1475-2840

VL - 20

JO - Cardiovascular Diabetology

JF - Cardiovascular Diabetology

M1 - 102

ER -

Sex differences in the association of prediabetes and type 2 diabetes with microvascular complications and function: The Maastricht Study

Abstract

Funding

UN SDGs

Keywords

Access to Document

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