Diabetes Care for Women Needs Improvement

Medical advances against diabetes of the last few decades have not benefited women, says a study reported in the Annals of Internal Medicine.

The findings challenge the conventional wisdom that women live longer than men.

Researchers found that the death rates of men with diabetes dropped in recent decades, while those of women with diabetes increased. It is not clear why the discrepancy exists.

Dr. Larry Deeb, spokesperson for the American Diabetes Association (ADA), says he really does not know why the study shows women have fallen behind.

"But I do know that it argues that something we're doing isn't right,” says Dr. Deeb. “If you're a woman, and you have diabetes, it may be we're not aggressive enough about taking care of you."

Statistics Say Women's Death Rates Rose

In the new study, researchers led by Edward Gregg, Ph.D., an epidemiologist with the Centers for Disease Control and Prevention (CDC), examined health surveys spanning 1971 to 2000 to determine the death rates of Americans with diabetes.

The researchers looked at about 27,000 persons. They found that among men with diabetes, the death rate from all causes dipped from 43 to 24 deaths per 1,000 persons between the two time periods.

Among men, "their mortality rates have declined," Dr. Gregg says, "and they've kept pace with their non-diabetic counterparts."

But among women with diabetes, the death rate actually rose from 18 to 26 per 1,000, even as the life span of women without diabetes grew longer.

Death rates from cardiovascular disease, in particular, stayed steady among women with diabetes while dropping among men with diabetes.

Why are women with diabetes at such high risk?

"We can speculate on a few possibilities, that risk factors for things such as heart disease haven't declined as much among women as in men," notes Dr. Gregg.

"Another possibility is that women haven't gotten as aggressive or comprehensive treatment as men have over the years," he says.

Dr. Deeb says the research appears to be sound.

An estimated 9.7 million American women have diabetes, and almost one-third of them do not know it. Women with diabetes are more likely to have a heart attack, and at a younger age, than women without diabetes, according to the ADA.

Diabetes is at least two to four times more common among African-American, Hispanic, American Indian, and Asian/Pacific Islander women than Caucasian women.

The risk for the disease increases with age. Given the increasing life span of women and the rapid growth of minority populations, the number of women in the US at risk for diabetes is increasing, the ADA states.

Second Study Shows Improvements

Meanwhile, a second new study says that women are now about as likely as men to get recommended screening tests and treatments to manage their diabetes.

According to the latest statistics from the Agency for Healthcare Research and Quality (AHRQ), for Americans age 40 and over with diabetes:

• The percentage of women who report being given three key recommended exams for diabetes - blood sugar, eye, and foot - increased from 37 percent in 2000 to 47 percent in 2003.

• During the same period, the percentage of men who reported receiving these exams rose only 3 percent from 46 percent to 49 percent.

• The proportion of women whose blood sugar level was optimal increased from 38 percent for the period 1988 to 1994 to 47 percent for 1999 to 2002.

• In contrast, the proportion of men with optimal blood sugar level fell from 44 percent to 43 percent during the period.

In spite of the narrowing disparities between the genders, fewer than 60 percent of Americans, as a whole, receive optimal care for their diabetes.

Always consult your physician for more information.

Diabetes Concerns

Clinical complications associated with diabetes may include the following:

cardiovascular disease
Cardiovascular disease, in many cases, is caused by atherosclerosis - an excess build-up of plaque on the inner wall of a large blood vessel, which restricts the flow of blood. Heart disease is the leading cause of diabetes-related deaths. Heart disease and stroke are two to four times more common in persons with diabetes.

hypertension
High blood pressure affects 73 percent of persons with diabetes.

dental disease
Periodontal (gum) disease occurs with greater frequency in persons with diabetes.

retinopathy or glaucoma (eye disease or blindness)
Blindness due to diabetic retinopathy is a more important cause of visual impairment in younger-onset people than in older-onset people. Males with younger-onset diabetes generally develop retinopathy more rapidly than females with younger-onset diabetes.
Diabetes is the leading cause of blindness among adults ages 20 to 74.

renal disease (kidney/urinary tract disease)
Ten percent to 21 percent of all people with diabetes develop kidney disease. Diabetes is the leading cause of end-stage renal disease (ESRD), a condition in which the patient requires dialysis or a kidney transplant in order to live.

neuropathy (nerve disease)
Approximately 60 percent to 70 percent of people with diabetes have mild to severe forms of diabetic nerve damage. Severe forms of diabetic nerve disease are the major contributing cause of lower-extremity amputations.

amputation
More than half the amputations in the US occur among people with diabetes.

diabetic ketoacidosis (DKA)
DKA is one of the most serious outcomes of poorly controlled diabetes, and primarily occurs in persons with type 1 diabetes. DKA is marked by high blood glucose levels along with ketones in the urine.

Persons with diabetes must stay alert for symptoms that can lead to clinical complications.

The best way to do this is to:

• get regular checkups - finding problems early is the best way to keep complications from becoming serious.
  
  
• keep appointments with your physician - even when you are feeling well.
  
  
• be aware of symptoms and warning signs - such as vision problems (blurriness, spots), fatigue, pale skin color, obesity (more than 20 pounds overweight), numbness or tingling feelings in hands or feet, repeated infections or slow healing of wounds, chest pain, vaginal itching, or constant headaches.
  
  
• carefully self-monitor blood sugar levels several times a day, as directed by your physician.
  
  
• control weight
  
  
• eat a healthy, well-balanced diet
  
  
• get regular exercise
  
  
• check your feet every day for even minor cuts or blisters
  
  
• quit smoking

Always consult your physician for more information.