Men, women experience diabetes in different ways

By Maria Perno Goldie, RDH, MS

As with most diseases, men and women experience diabetes in different ways. This article will highlight some of the differences in how diabetes is expressed in women and men.Women with diabetes usually have more symptoms and complications than men with diabetes. An example is stroke. Several studies have demonstrated that the influence of diabetes on stroke risk is higher in women than in men.(1, 2) A significant difference in stroke risk was evident in women aged 55-64 years, suggestive of the fact that diabetic women in the first ten years after menopause may need more aggressive preventive care.(3) This disparity was discovered in a 2007 study that found that death rates between 1971 and 2000 declined for men with diabetes, while rates for women with diabetes stayed the same.(4) Another difference is that men with diabetes live an average of 7.5 years less than individuals without diabetes, and women about 8.2 years less than those without the disease.

The reason for the difference is a combination of factors. Endogenous sex hormones may be implicated in the development of type 2 diabetes in women. In a prospective study of over 500 women and men who did not have diabetes upon study entry, development of diabetes was associated with low levels of total testosterone in men and high levels of bioavailable testosterone in women.(5) Differences in physiology is a factor, but the fact that physicians treat men and women differently may play a role, as well.(6) The difference in care provided can result in inferior outcomes for women.(6) Women tend to live longer than men, mainly because they have lower rates of heart disease. After menopause, this risk becomes more equivalent.(7) However, when women have diabetes, the benefit seems to disappear. The risk for heart disease is six times higher for women with diabetes than those without the disease.(8) In comparison, in men with diabetes, the risk for heart disease increases two- to threefold.

Data also show that women with diabetes are more likely than men with the disease to have poor blood glucose control, be obese, and have high blood pressure and unhealthy cholesterol levels. Compared to diabetic men, diabetic women produced less glucose to counteract hypoglycemia.(9) Another factor to consider is that women can become pregnant. Approximately 2-5% of all non-diabetic pregnant women develop gestational diabetes, a form of diabetes that occurs only during pregnancy. Women who developed gestational diabetes are at an increased risk (~45%) of developing it again with subsequent pregnancies.10 Five to ten percent of women diagnosed with gestational diabetes will develop type 2 diabetes after pregnancy, and 20-50% will develop the disease in the next 5-10 years.(11) Children of women who are diagnosed with gestational diabetes are more likely to become obese during childhood and have diabetes later in life.(10) Kidney disease is another complication of diabetes, and is worse in women than in men. On the whole, men have a higher risk for kidney disease, but that changes when a woman has diabetes. Kidney disease normally does not affect women until menopause.(12) Another fact is that depression is about twice as common in women as it is in men, and may have a greater effect on women with diabetes than on men with diabetes.(13) This 2010 study of women hypothesized that depression increases the risk of diabetes and vice versa.

As you can see, diabetes is not an equal opportunity disease. Regarding oral health, diabetes is another health concern for women and men. Research has shown that having periodontal disease can increase your chances of developing diabetes.(14) Other studies have shown that those with diabetes and poor oral health have a more difficult time controlling their blood sugar levels.(15) Non-surgical periodontal treatment can effectively control periodontal inflammation and reduce serum hsCRP (C reactive protein) level in type 2 diabetes patients with periodontitis.(14) The American Academy of Periodontology supports the Clinical guidelines from the International Diabetes Federation (IDF). These guidelines emphasize the importance of periodontal health for people with diabetes.(16) Diabetes affects approximately 285 million people worldwide, and this number is only expected to increase. The IDF is an organization of 200 national diabetes associations from 160 countries. ADHA has a fact sheet that can be printed and distributed to patients.(17) It is essential to take a good medical history, provide risk assessment, and treat appropriately to control diabetes and periodontal disease.References
1. Goldstein, L.B., et al., Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke, 2001. 32(1): p. 280-99. 2. Lukovits, T.G., T.M. Mazzone, and T.M. Gorelick, Diabetes mellitus and cerebrovascular disease. Neuroepidemiology, 1999. 18(1): p. 1-14. 3. Almdal, T., et al., The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med, 2004. 164(13): p. 1422-6. 4. Gregg EW , Gu Q, Cheng YJ, Narayan KMV, and Cowie CC. Mortality Trends in Men and Women with Diabetes, 1971 to 2000. Annals of Internal Medicine, August 7, 2007 vol. 147 no.3, 149-155. 5. Oh, J.Y., et al., Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study. Diabetes Care, 2002. 25(1): p. 55-60.6. Barrett-Connor, E., et al., Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med, 2004. 164(9): p. 934-42.7. Women and cardiovascular diseases-Statistics. 2004 American Heart Association www.heart.org/HEARTORG/.8. Juutilainen, A., et al., Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care, 2004. 27(12): p. 2898-904. 9. Davis, S.N., S. Fowler, and F. Costa, Hypoglycemic counterregulatory responses differ between men and women with type 1 diabetes. Diabetes, 2000. 49(1): p. 65-72.10. Diabetes & women's health across the life stages. 2001. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. www.cdc.gov/diabetes/pubs/women/. 11. Interim Report: Proposed recommendations for action. A national public health initiative on diabetes and women's health. 2001. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. www.cdc.gov/diabetes/pubs/interim/index.htm. 12. Gebel E. How Diabetes Differs for Men and Women. Christine Maric-Bilken, PhD, quote in Diabetes Forecast. 13. Pan A, Lucas M, Sun Q, van Dam RM, Franco OH; Manson JE; Willett WC; Ascherio A, and Hu FB. Bidirectional Association Between Depression and Type 2 Diabetes Mellitus in Women. Arch Intern Med. 2010;170(21):1884-1891. 14. Chen L, Luo G, Xuan D, Wei B, Liu F, Li J, and Zhang J. Effects of Non-surgical Periodontal Treatment on Clinical Response, Serum Inflammatory Parameters, and Metabolic Control in Type 2 Diabetic Patients: A Randomized Study. Posted online on 22 August 2011.15. Santacroce L, Carlaio RG, Bottalico L. Does it make sense that diabetes is reciprocally associated with periodontal disease? Endocrine, Metabolic & Immune Disorders-Drug Targets 2010;10:57-70.16. IDF Clinical Guidelines Task Force. Global guideline for Type 2 diabetes. Brussels: International Diabetes Federation, 2005. www.idf.org/webdata/docs/IDF%20GGT2D.pdf. 17. www.adha.org/downloads/factsheets/diabetes.pdf. Additional reading
Medical history review: 'Red flags? to prevent medical emergencies www.dentistryiq.com/index/display/article-display/4693861960/articles/dentisryiq/hygiene-department/2010/08/Medical_history_Gurelian_part_2.htmlThe Diabetic Dilemma www.dentistryiq.com/index/display/article-display/343378/articles/rdh/volume-28/issue-10/feature/the-diabetic-dilemma.htmlPeriodontal disease and diabetes: A two-way street www.ada.org/sections/professionalResources/pdfs/Perio_diabetes.pdfDevelopment of a clinical guideline to predict undiagnosed diabetes in dental patients. www.ada.org/members/sections/scienceAndResearch/jada_indian_mar_2011_diabetes.pdf