德国和法国成人 1 型糖尿病一级预防中心血管危险因素及其管理的性别不平等：来自 DPV 和 SFDT1 的研究结果。
Sex inequalities in cardiovascular risk factors and their management in primary prevention in adults living with type 1 diabetes in Germany and France: findings from DPV and SFDT1.
机构信息
Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, 125 Rue de Stalingrad, 93000, Bobigny cedex, France.
Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, 93017, Bobigny, France.
出版信息
Cardiovasc Diabetol. 2024 Sep 16;23(1):342. doi: 10.1186/s12933-024-02419-4.
INTRODUCTION & OBJECTIVES: To evaluate whether cardiovascular risk factors and their management differ in primary prevention between adult males and females with type 1 diabetes (T1D) in two European countries in 2020-2022 and sex inequalities in achievement of standards of care in diabetes.
METHODS
We used 2020-2022 data of patients without a cardiovascular history in the Prospective Diabetes Follow-up registry (DPV) centres, in Germany, and the Société Francophone du Diabète- Cohorte Diabète de Type 1 cohort (SFDT1), in France.
RESULTS
We included 2,657 participants from the DPV registry and 1,172 from the SFDT1 study. Body mass indexes were similar in females and males with similar proportions of HbA1c < 7% (DPV: 36.6 vs 33.0%, p = 0.06, respectively; SFDT1: 23.4 vs 25.7%, p = 0.41). Females were less overweight compared to men in DPV (55.4 vs 61.0%, p < 0.01) but not in SFDT1 (48.0 vs 44.9%, p = 0.33) and were less prone to smoke (DPV: 19.7 vs 25.8%, p < 0.01; SFDT1: 21.0 vs 26.0%, p = 0.07). Systolic blood pressure was lower in females than males with a higher rate of antihypertensive therapy in case of hypertension in females in DPV (70.5 vs 63.7%, p = 0.02) but not in SFDT1 (73.3 vs 68.6%, p = 0.64). In the case of microalbuminuria, ACEi-ARB were less often prescribed in women than men in DPV (21.4 vs 37.6%, p < 0.01) but not SFDT1 (73.3 vs 67.5.0%, p = 0.43). In females compared to males, HDL-cholesterol levels were higher; triglycerides were lower in both countries. In those with LDL-cholesterol > 3.4 mmol/L (DPV: 19.9 (females) vs 23.9% (males), p = 0.01; SFDT1 17.0 vs 19.2%, p = 0.43), statin therapy was less often prescribed in females than males in DPV (7.9 vs 17.0%, p < 0.01), SFDT1 (18.2 vs 21.0%, p = 0.42).
CONCLUSION
In both studies, females in primary prevention have a better cardiovascular risk profile than males. We observed a high rate of therapeutic inertia, which might be higher in females for statin treatment and nephroprotection with ACEi-ARB, especially in Germany. Diabetologists should be aware of sex-specific differences in the management of cardiorenal risk factors to develop more personalized prevention strategies.
目的
评估 2020-2022 年两个欧洲国家的成年男性和女性的 1 型糖尿病（T1D）一级预防中心血管危险因素及其管理是否存在差异，以及糖尿病护理标准的达标情况是否存在性别差异。
方法
我们使用了德国的 Prospective Diabetes Follow-up registry（DPV）中心和法国的 Société Francophone du Diabète-Cohorte Diabète de Type 1 研究（SFDT1）2020-2022 年的数据。
结果
我们纳入了来自 DPV 登记处的 2657 名参与者和来自 SFDT1 研究的 1172 名参与者。女性和男性的体重指数相似，HbA1c<7%的比例也相似（DPV：36.6%与 33.0%，p=0.06；SFDT1：23.4%与 25.7%，p=0.41）。与男性相比，女性在 DPV 中心的超重比例较低（55.4%与 61.0%，p<0.01），但在 SFDT1 中心（48.0%与 44.9%，p=0.33）则没有差异，且吸烟比例较低（DPV：19.7%与 25.8%，p<0.01；SFDT1：21.0%与 26.0%，p=0.07）。与男性相比，女性的收缩压较低，且在 DPV 中心高血压女性接受降压治疗的比例较高（70.5%与 63.7%，p=0.02），但在 SFDT1 中心（73.3%与 68.6%，p=0.64）则没有差异。在微量白蛋白尿的情况下，与男性相比，女性接受 ACEi-ARB 治疗的比例较低（DPV：21.4%与 37.6%，p<0.01），但在 SFDT1 中心（73.3%与 67.5.0%，p=0.43）则没有差异。与男性相比，女性的高密度脂蛋白胆固醇水平较高，甘油三酯水平较低。在 LDL-胆固醇>3.4mmol/L 的患者中（DPV：19.9%（女性）与 23.9%（男性），p=0.01；SFDT1 17.0%与 19.2%，p=0.43），女性接受他汀类药物治疗的比例低于男性（DPV：7.9%与 17.0%，p<0.01），SFDT1 中心（18.2%与 21.0%，p=0.42）。
结论
在这两项研究中，一级预防中的女性心血管风险状况优于男性。我们观察到治疗惰性的比例较高，尤其是在德国，女性接受他汀类药物治疗和 ACEi-ARB 肾保护治疗的比例可能更高。糖尿病专家应该意识到管理心血管和肾脏危险因素方面的性别差异，以便制定更个性化的预防策略。
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