Sex-Based Disparities in Type 1 Diabetes Begin in Pediatric Care

Silvia de Vries, MD, MSc

A review of more than 90 published studies suggests sex-based disparities in the care of type 1 diabetes in pediatric populations could be contributing to differences in outcomes observed among male and female patients.

Leveraging data from more than 640,000 pediatric patients with type 1 diabetes, results of the study indicate differences in clinical care of children and adolescents with type 1 diabetes, particularly in regard to glycemic control, insulin dosing, and weight management, could play a role in the higher mortality rates and excess cardiovascular risks observed among female populations with type 1 diabetes.¹

“This systematic review on sex differences in children with type 1 diabetes has shown that several outcomes appear to be worse in the female sex when compared with their male counterparts, particularly regarding BMI, glycaemic control, [insulin dose], diabetic ketoacidosis and [quality of life],” wrote investigators.

Despite advances and an emphasis in research as well as new initiatives, existing data outlines clear disparities in the care of women with diabetes compared to their male counterparts. In September 2022, data from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study found women with type 1 diabetes had a lower burden of cardiometabolic risk factors, receive less aggressive cardioprotective medications, but experienced a similar burden of cardiovascular disease event rate as men.²

Citing these disparities in outcomes, a team led by Silvia de Vries, MD, MSc, of the University of Amsterdam Medical Center, launched the current study to provide an overview of sex differences in children with type 1 diabetes, with a specific focus on patient and disease characteristics, treatment, comorbidities, and complications. To do so, investigators designed the systematic review to include observational cohort, cross-sectional, and case-control studies published within the MEDLINE from inception through June 15, 2021.

From their search, investigators identified 8640 articles for potential inclusion. Of these, 90 studies encompassing a total population of 643,217 individuals with type 1 diabetes were identified for inclusion in the systematic review. For inclusion, studies needed to have a primary outcome that mentioned a sex difference in outcome. For the purpose of analysis, articles reporting sex differences were identified and assessed on quality and risk of bias.

Upon analysis, results indicated most of the studies included demonstrated female children had a higher HbA1c at clinical diagnosis and during treatment. Results indicated female children also had a steeper HbA1c increase over time. In studies reporting BMI, results suggested female patients with type 1 diabetes had a higher BMI, a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidemia than their male counterparts.

Additional analyses revealed female patients with type 1 diabetes used pump therapy more frequently, needed higher insulin doses, and were hospitalized more frequently than their male counterparts. These analyses also revealed male patients with type 1 diabetes were more likely to experience hypoglycemia, partial remission, and diabetic ketoacidosis than their female counterparts. Investigators called attention to multiple other notable results from their analyses, including a lower quality of life for female patients with type 1 diabetes, which was observed in all studies reporting on quality of life.

References

1. de Vries SAG, Verheugt CL, Mul D, Nieuwdorp M, Sas TCJ. Do sex differences in paediatric type 1 diabetes care exist? A systematic review - diabetologia. SpringerLink. https://link.springer.com/article/10.1007/s00125-022-05866-4. Published January 26, 2023. Accessed February 2, 2023.

2. Campbell P. Despite improved risk profiles, women with type 1 diabetes face increased CVD risk. Endocrinology Network. https://www.endocrinologynetwork.com/view/despite-improved-risk-profiles-women-with-type-1-diabetes-face-increased-cvd-risk. Published September 8, 2022. Accessed February 2, 2023.