COMMENTARY

Life Expectancy Shorter in Women With Type 2 Diabetes vs Men

Adrian H. Heald, MRCP, MRCPsych, DM; Mark Harmel, MPH, CDCES

Disclosures

October 04, 2022

This transcript has been edited for clarity.

It's great to be able to talk to you today about our new data for people with type 2 diabetes from Salford in the United Kingdom. We're very fortunate in that, within the population of Salford, we've been able to follow up with everybody who lives there for a 20-year period.

Salford is an industrial city in the north of England. The people are predominantly of White European ethnicity. Within the cohort that we looked at, we have more than 11,000 people with type 2 diabetes who were diagnosed around 2010 and subsequently, so we followed up with them between 2010 and 2020.

In this study, we were particularly interested in the differences in outcomes between men and women. However, we looked at other factors, including the age at which people were diagnosed with type 2 diabetes and the duration of type 2 diabetes. We also looked at body mass index, smoking, and the way that social disadvantage impacts mortality in this group of people.

The key findings for this 10-year follow-up — which incidentally stop at the start of 2020, just before the COVID-19 pandemic — are that women have a higher mortality rate than men, as measured by the standardized mortality ratio. In this case, it was adjusted for social disadvantage because, as I've alluded to, Salford has a higher level on average social disadvantage than the average for England.

The standardized mortality rate, adjusted for deprivation, is significantly higher for women than for men. Importantly, the life-years that they lose from having the condition is more than for men: just under 5 years for women compared with under 4 years for men.

This is a really important finding in understanding health outcomes for women in the United Kingdom and women with type 2 diabetes in the United Kingdom.

Other factors that significantly shortened life expectancy, apart from being a woman vs a man, were being a smoker; even within the group of people who live in Salford, being more socially disadvantaged; and also having a longer duration of diabetes. Interestingly, having a younger age at diagnosis of type 2 diabetes was also a factor that acted to potentially shorten people's life expectancy vs the general population.

In terms of why this is, we're not able to formally explore this in this study, as it is a register study. It may be related to body composition factors. We know that the body shape and the distribution of fat vs muscle is different in women than in men.

We also know that generally, in relation to, should we say, dysmetabolic risk, women develop type 2 diabetes later than men do in terms of formally reaching the level of glucose that would result in a diagnosis of type 2 diabetes. Therefore, it may be that they accumulate multiple risk factors even before they've been diagnosed with type 2 diabetes.

Furthermore, there are significant hormonal changes that occur in every woman after menopause, and this may have a particularly profound effect in terms of perturbing lipid profile, lipid action, and LDL receptor function in women as they cross the threshold from premenopause to perimenopause and into full menopause.

Also of note is that there are differences in prescribing medication. Within this group, for example, we found that women take less SGLT2 inhibitors than men. We know that there is a very significant benefit of SGLT2 inhibitors in men. Of course, the period that we're looking at starts before the SGLT2 inhibitors were on the market and available in the United Kingdom. Certainly, treatment availability factors, treatment concordance factors, as well as body composition and hormonal factors may be acting here.

What we found here — and this is an important take-home message — is that women with type 2 diabetes actually have a shortened life expectancy compared with men with type 2 diabetes. We know that type 2 diabetes itself significantly shortens life expectancy, but the increase in life-years lost for women was nearly 1 year more than it was for men.

Thank you very much for listening.

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