Women With Diabetes Left Behind In Drop In Death Rates

Edward W. Gregg, PhD, acting chief, Epidemiology and Statistics Branch of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) and lead author of the study, says that the study uncovered the gender disparity in death rates but was not designed to answer its causes.

"The improvements seen in men suggest that the improvements in diabetes care are working on longevity as well," said Gregg. "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."

Study authors looked at data from 20,000 people, aged 35 to 74, in one of the National Health and Nutrition Examination Surveys (NHANES) I, II, and III and followed participants for up to 12 years to see who was still living and who died.

Researchers found that the death rates from all causes in men with diabetes fell steeply from 42.6 to 24.4 annual deaths per 1,000 people, a 43 percent relative reduction in age-adjusted death rate, while the death rate from cardiovascular disease (CVD), the most common cause of death in people with diabetes, fell from 26.4 to 12.8. In the same period, neither the all-cause nor CVD death rate for women with diabetes declined.

Overall, Americans live longer today than 35 years ago. The study showed that the overall death rate for people who did not have diabetes fell from 14.4 to 9.5 annual deaths per 1,000 people. When the authors analyzed the data by sex and by diabetes status, the startling difference in women with and without diabetes appeared.

In general, people with diabetes have a higher risk of dying earlier than people without the disease. In this study the death rate of men with diabetes remained higher than that of men without diabetes but over the decades it decreased in parallel with the decrease in men without diabetes. These same favorable trends were not present in women with diabetes.

The study did not investigate the reasons for the sex-related difference in death rates.

Dr. Gregg explained, "Some studies have suggested women have had less improvement in 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."

An editorial accompanying the article suggests that part of the reason for the sex differences may be the well-described lower rates of treating cardiovascular risk factors and established coronary heart disease in women.

In the last 35 years, diabetic care has improved, with efforts to maintain tight control of blood sugar, cholesterol and blood pressure levels and with more routine use of flu and pneumonia vaccines and regular exams of eyes feet, and teeth. New drug treatments have come to market.

What can a woman with diabetes do to live as long as possible" The American College of Physicians suggests: Make sure you are under a doctor's care. Have blood sugar, cholesterol levels and blood pressure checked regularly and maintain tight control of these key markers of diabetes and heart health. Get regular checkups of your eyes, feet, and kidney function. If you're overweight, lose weight. If you smoke, quit. Eat a healthy diet (fewer carbohydrates, sweets and starches that affect blood sugar levels). Take your medications as directed. Be physically active.

The study, "Mortality Trends in Men and Women with Diabetes, 1971-2000," and the editorial "Heightened Cardiovascular Risk in Diabetic Women: Can the Tide be Turned"" will appear on the Web site of Annals of Internal Medicine  June 18 . It will appear in the Aug. 7, 2007, print edition of the journal.