Title:Sex-Gender Differences in Diabetes Vascular Complications and Treatment
Volume: 12
Issue: 2
Author(s): Flavia Franconi, Ilaria Campesi, Stefano Occhioni and Giancarlo Tonolo
Affiliation:
Keywords:
Cardiovascular diseases, diabetic complications, diabetes mellitus, risk factors, sex-gender differences, therapy
Abstract: Diabetes mellitus and cardiovascular diseases act as two sides of the same coin: diabetes is an important
risk factor for cardiovascular disease while patients with ischemic cardiovascular diseases often have diabetes or
pre-diabetes. As firstly shown by Framingham study, diabetic women have an increased cardiovascular risk about 3.5 fold
higher than non diabetic women, against an increase of “only” 2.1 fold found in male subjects. In view of the impact of
sexual hormones on glucose homeostasis, the molecular pathways involved in insulin resistance suggest a sex-gender
specificity mechanism in the development of diabetic complications leading to the unmet need of sex-gender therapeutic
approaches. This has also been seen in other diabetic complications such as renal diseases, which seems to progress at a
faster rate in females compared with males and women benefit less from treatment than do men. Of note, none of the trials
done so far are primarily designed to assess sex-gender differences in the benefit from a specific intervention strategy, de
facto excluding fertile women from experimentation. In order to provide a more evidence based medicine for women and
to reach equity between men and women, sex-gender epidemiological reports, preclinical and clinical research are
mandatory to evaluate the impact of gender on the outcomes and to improve sex-gender awareness and competency in the
health care system. Future studies should consider sex-gender differences in the setting of randomized controlled trials
with drugs.
