The aim of this study was to determine whether there were sex disparities in treatment among men and women with type 2 diabetes treated in primary care in the Netherlands. Differences were evaluated according to a comprehensive set of prescribing quality indicators covering blood glucose, blood pressure, lipids and albuminuria, and detailing whether medications were prescribed when needed, timely initiation and escalation, and medication safety.
A total of 10 456 participants were evaluated, of whom 47% were female. Women tended to be older, with a longer diabetes duration, higher BMI, lower eGFR and more commonly LDL-cholesterol levels over 2.5 mmol/L. Conversely, men were more likely to have albuminuria and a history of cardiovascular disease.
Regarding prevalent and first-line medications, women were less likely to be receiving ongoing therapy with metformin (odds ratio [OR], 0.70), statins (OR, 0.80), and RAS blockers for blood pressure (OR, 0.55) or for albuminuria (OR, 0.64). They were also less likely to initiate statin therapy when needed (OR, 0.75). No sex disparities were seen in terms of medication safety.
The fact that there were no significant sex differences in terms of starting metformin or RAS blockers, but that women were less likely to receive ongoing treatment with these agents, might be explained by greater rates of adverse reactions to these therapies in women. However, the authors propose that the lower rates of statin initiation and continuation are likely to be explained at least partly by clinical inertia.
The authors conclude that it is concerning that women are less likely to receive treatment with statins and RAS blockers when they are needed, and that this may partially explain the previously observed excess risk of cardiovascular and renal complications in women compared to men with type 2 diabetes (Peters et al, 2014a; 2014b; Shen et al, 2017).