A drop in deaths among men with diabetes, but not in women

By LEE BOWMAN
Scripps Howard News Service
Thursday, June 21, 2007

The death rate for men with diabetes has dropped substantially in the past three decades, but women with the condition don't seem to be enjoying the same progress.

A new study by federal researchers published online this week by the American College of Physicians shows that while death rates from all causes declined by 43 percent among men with diabetes between 1971 and 2000, they did not change at all for women with diabetes.

The death rate for heart disease among men with diabetes fell by more than half, from 26.4 per 1,000 to 12.8 per 1,000 in the same period, but again, the death rate for women was static.

Overall, the study showed that the decline in death rates for diabetic men mirrored a decline in death rates for all Americans during the study period.

"The improvements seen in men suggest that the improvements in diabetes care are working on longevity as well," said Edward Gregg, acting chief of epidemiology and statistics in the diabetes division of the federal Centers for Disease Control and Prevention, and lead author of the study.

"But the finding in women is concerning, and means we may need to explore whether different approaches are needed to improve health outcomes for women with diabetes."

The study included information from nearly 20,000 people, ages 35 to 74, who took part in one of three national health surveys between 1971 and 1994. Among the questions asked was whether the individual had diabetes.

The researchers then followed the people for up to 12 years to see who was still living and who had died. Then they compared the numbers of deaths in those with and without diabetes from the 1990s with those surveyed in the 1980s and 1970s. They also compared death rates in men and women.

In general, people with diabetes have a higher risk of dying earlier than those without diabetes. High blood-sugar levels lead to blindness, kidney failure, nerve damage and heart disease, among other things.

Historically, men are more likely to be diagnosed with diabetes than women. But the difference between the sexes after diagnosis was striking.

Gregg said the design of the study didn't give any possible answers about why women with diabetes are faring worse than men, but he offered several possible factors.

"Some studies have suggested women have had less improvement in their heart-disease-risk factors in recent years. Other studies suggest women receive less-aggressive care for heart disease and risk factors. Still other studies suggest that heart disease and diabetes may take a subtly different form in women, and that different types of treatments are needed," he said.

Overall, diabetes monitoring and care has made great strides in the last three decades, and many people are able to combine a good diet, exercise and medications to control blood sugar, blood pressure and cholesterol levels to avoid development of major diabetic complications.

But other new findings, from the federal Agency for Healthcare Research and Quality, suggest that the problem for women may lie deeper that getting routine care.

It found that among Americans 40 and older with diabetes, the percentage of women who reported being given three key recommended exams for diabetes -- blood sugar, retinal and foot -- increased from 37 percent in 2000 to 47 percent in 2003.

During that same period, the percentage of men who reported getting the exams annually rose from 46 percent to 49 percent.

Also, the proportion of diabetic women with optimal blood-sugar levels went from 38 percent during 1988-94 to 47 percent between 1999-2002. By contrast, the proportion of men with optimal blood-sugar levels fell from 44 percent to 43 percent in the same period.

Of course, the surveys also showed that aside from the gender differences, less than 60 percent of all diabetic Americans are getting optimal care for the disease.

The government estimates that more than 21 million Americans over age 20 have diabetes, but that at least a third don't know they have it. More than 1.5 million new cases are diagnosed each year.

On the Net: http://www.cdc.gov/diabetes

www.diabetes.org