Diabetes increases the risk of heart failure, more so in women than men

Research summary

An international study led by The George Institute for Global Health, involving 12 million participants, has found that in people with diabetes, women face a greater risk of developing heart failure compared with men. The research identified that Type 1 and Type 2 diabetes are associated with a 47% and 9% greater excess risk of developing heart failure, respectively, for women compared with men.

 What is Type 1 diabetes? What is Type 2 diabetes?

Find out more about the risk factors, prognosis and treatment for Heart Failure

 Diabetes is one of the main causes of cardiovascular disease, blindness, kidney failure and lower-leg amputations. Poorly controlled diabetes during pregnancy increases the risk of complications, both for the mother and foetus. Depression is also significantly increased in women with type 2 diabetes compared with men.

 Dr Toshiaki Ohkuma from the George Institute commented, “It is already known that diabetes puts you at greater risk of developing heart failure but what our study shows for the first time is that women are at far greater risk – for both type 1 and type 2 diabetes.

 “The increased risk of heart failure following a diabetes diagnosis is significantly greater in women than men which highlights the importance of intensive prevention and treatment of diabetes in women. Further research is required to understand the mechanisms underpinning the excess risk of heart failure conferred by diabetes [particularly type 1] in women and to reduce the burden associated with diabetes in both sexes.”

 The International Diabetes Federation (IDF) estimates that nearly 200 million women around the world live with diabetes, out of 415 million diabetic adults worldwide. By 2040, the number of women affected by diabetes is expected to rise to 313 million.1 Diabetes – the 9th biggest killer in women globally – currently claims 2.1 million female lives every year, which is more than men.

 According to Diabetes Australia, diabetes has become the major health crisis of the 21st century and is perhaps the greatest challenge facing Australia’s health care system, with 1.7 million Australians suffering from the disease.

 Co-author of the study, Dr Sanne Peters, mentioned that there are numerous reasons why women with diabetes have an increased risk of heart complications.

“Women were reported to have two years’ longer duration of prediabetes than men and this increased duration may be associated with greater excess risk of health failure in women.

 “Some major concerns are that women are also being undertreated for diabetes, are not taking the same levels of medications as men and are less likely to receive intensive care.”

 The IDF details that gender inequality challenges – such as gender roles, power imbalances, socioeconomic inequalities that lead to poor diet and lack of physical activity – can all influence vulnerability to diabetes for women. The limited access to health services and lack of pro-activity to seek help for health issues, can also accentuate the impact of diabetes on women, especially in developing countries.1

 Commentary

 Men are from Mars, Women are from Venus – The need for sex- and gender-specific research

 As alluded to in the study, there is urgent need for sex- and gender-specific research.^2,3 The default health research model for common diseases has generally been, up until now, one that involves only (or predominantly) male participants. A pertinent example of this was the then-widely acclaimed Harvard University research, initiated in 1981, that examined the effects of aspirin on cardiovascular disease. Remarkably, out of the 22,000 participants in the study, not one single participant was female.4,5 For many years, the research norm was to assume that the occurrence and outcomes of disease would be the same for women. However, an increasing body of evidence proves that this is not the case.^2,3

 In 2015, the George Institute, in collaboration with the University of Oxford, proposed a new global agenda for women’s health. The report highlighted how efforts to improve the health of women and girls has, up until now, largely remained limited to reproductive health, birthing and childcare. Thus, there is an urgent need for a broader and redefined agenda that also focuses on the major causes of death and disability for women. Research that priorities a gendered approach forms a key part of this agenda.³

 The George Institute for Global Health is at the forefront of sex- and gender-specific research, having already ascertained that women with diabetes have a much greater risk of stroke, coronary heart disease, dementia and some forms of cancer.

References

1.  Diabetes Voice (online). Diabetes is a serious women’s health issue [accessed 12 August 2019]. Available from: URL link
2. The George Institute for Global Health UK (online). Women’s health and sex inequalities [accessed 12 August 2019]. Available from: URL link
3. Oxford Martin Policy Paper 2015 (online). Women’s Health: A New Global Agenda [accessed 12 August 2019]. Available from: URL link
4. Science in the News: Harvard University (online). Treating Men and Women Differently: Sex differences in the basis of disease [accessed 12 August 2019]. Available from: URL link
5. Physician’s Health Study 1: Harvard University (online). Physician’s Health Study 1 [accessed 12 August 2019]. Available from: URL link
6. UNSW Sydney Newsroom (online). Diabetes increases the risk of heart failure, more so in women than men [accessed 13 August 2019]. Available from: URL link