Are Women with Diabetes
Under-treated for Dyslipidemia?
Sherrie H. Kaplan, PhD, MPH
Professor of Medicine
UCI School of Medicine
Academy Health
2006 Annual Research Meeting
Background
• Less than 1/3 of men and 1/5 of
women with diabetes have LDL-levels
at target (<100mg/dl), Jacobs MJ, et
al., Diab Res and Clin Pract 2005,
70:263-269
• Underuse of lipid-lowering therapy
among women with cardiovascular
disease (HERS, PREVENT, etc.)
Background
• Physician gender bias in prescribing of
lipid lowering therapies among women
with CAD (Abuful A, et al.)
• Diabetes greater risk factor for ischemic
heart disease for women than for men
(Barrett-Connor, et al., JAMA 1991;
Larsson, et al., Diabetes Care; BarrettConnor, et al., Arch Intern Med, etc.)
Background
• At same lipid levels, women with
cardiovascular disease have lower
mortality risk compared to men;
women with diabetes have same or
greater mortality risk compared to men
Research Questions
• Are there gender differences:
– in monitoring lipid levels among
patients with diabetes?
– in lipid control among patients with
diabetes?
• If so, are there gender differences in
overall quality of diabetes care?
• Do findings persist across patient
samples?
Study Samples
• Patients of physicians participating in the
ADA Provider Recognition Program
(n=7364)
• Patients with diabetes at Kaiser
Permanente Georgia (n=14,671)
• Patients participating in the UCI
Diabetes Coached Care Program (n=272)
Patient Characteristics:
PRP Sample
Patient
Characteristics
Males
(n=3368)
Females
(n=3996)
P-value
Mean age
61.2
60.9
NS
% some college
29.6
19.4
<.001
Health rating
54.5
51.3
NS
% on insulin
49.3
52.7
NS
Patient Characteristics:
Kaiser Sample
Patient
Characteristics
Males
(n=7394)
Females
(n=7277)
P-value
Mean age
56.1
54.3
NS
Percent minority
45.8
51.2
<.001
Mean BMI
32.3
34.3
NS
% on insulin
19.4
19.8
NS
Patient Characteristics:
UCI Sample
Patient
Characteristics
Males
(n=61)
Females
(n=106)
P-value
Mean age
64.4
65.5
NS
% some college
58.4
26.6
<.001
Health rating
43.1
34.9
NS
Gender Differences in Lipid
Monitoring and Control
Quality Measure
Sample
Monitoring lipids PRP
LDL < 100mg/dl
Monitoring lipids KPG
LDL < 100mg/dl
Monitoring lipids UCI
LDL < 100mg/dl
Males Females P-value
86.8
38.1
67.3
34.4
100
61.7
84.3
31.2
65.3
24.7
100
51.8
NS
<.001
NS
<.001
NS
<.001
Gender differences in overall
quality of diabetes care: PRP
Quality Measure
Males
Females P-value
Annual HbA1c
97.7
98.4
NS
Annual urine protein
49.7
48.6
NS
Annual eye exam
68.5
69.0
NS
Annual foot exam
94.3
94.2
NS
HbA1c < 8 mg/dl
65.8
66.7
NS
BP <130/80
41.9
41.6
NS
Gender differences in overall
quality of diabetes care: KPG
Quality Measure
Males
Females P-value
Annual HbA1c
67.3
62.7
<.001
Annual blood pressure
71.1
64.8
<.01
HbA1c < 8 mg/dl
53.4
57.3
<.001
BP <130/80
35.0
35.4
NS
Gender differences in overall
quality of diabetes care: UCI
Quality Measure
Males
Females P-value
Annual HbA1c
100
100
NS
Annual foot exam
90.2
98.1
<.01
HbA1c < 8 mg/dl
89.2
92.5
<.001
BP <130/80
35.0
35.4
NS
Results of multi-variable analyses
• In separate logistic regression models
predicting LDL <100 and <130, gender
significant, adjusted for age, education,
health status and on insulin
• Odds ratio for treatment with statins if
LDL >130 for women = 0.77, p< .001
(KPG data only)
Summary
• With no differences in the overall quality
of diabetes care, nor in monitoring of
lipids, women have poorer lipid control
• Results observed in three different
patient samples
• Women with diabetes and poor lipid
control significantly less likely to be on
statins
Policy Implications
• For patients with diabetes, women may
be under-treated for dyslipidemia
• Women with diabetes should be
targeted for more aggressive treatment
to reduce LDL levels and subsequent
cardiovascular risk