Sex differences in the incidence of complications among people with diabetes in a South Indian population: 12 years follow up of CURES study (CURES-159)

Background & objectives Little data exist on population-based incidence of diabetes related complications in developing countries. We assessed sex-specific incidence of complications among Asian Indians with type 2 diabetes (T2D) based on follow up assessments from a community-based cohort. Methods We evaluated incident complications among individuals with T2D identified in the Chennai urban rural epidemiological study (CURES) conducted in 2001–03, who were complication-free at baseline and re-assessed once during a follow up survey in 2012–14. Diabetic retinopathy was assessed using retinal photography, diabetic peripheral neuropathy using biothesiometry, diabetic kidney disease using urinary albumin excretion and estimated glomerular filtration rate (eGFR), peripheral artery disease by ankle-brachial index, and coronary artery disease using medical history of coronary artery disease and/or Minnesota coding of ECGs. Cumulative incidence reflected the proportion developing each complication during a specified period of time, and relative risk analysis identified associated risk factors. Results Among 1,053 participants [men= 453(43%)], assessed in a cross-sectional manner about a decade later, the cumulative incidence rates differed by sex: women showed higher rates of diabetes kidney disease (36.1 vs . 31.4%) and peripheral artery disease (35.4 vs . 23.9%) whereas men had higher rates of diabetic retinopathy (37.0 vs. 27.3%) and coronary artery disease (36.2 vs . 34.5%). The incidence of peripheral neuropathy was comparable between men (63%) and women (62.7%). After adjusting for confounding variables compared to men, women had higher risk for peripheral artery disease [range (RR:1.62, 95% confidence interval (CI):1.20-2.17] but a lower risk for diabetic retinopathy (RR:0.75,95% CI:0.59-0.97) and coronary artery disease (RR:0.60, 95% CI:0.49-0.75). Interpretation & conclusions Women have a higher risk of peripheral arterial disease and lower risk of diabetic retinopathy and coronary artery disease, while there were no sex differences for developing kidney disease and peripheral neuropathy.