Key result
Female T2D patients are ~30% less likely to receive metformin than males, alongside fewer statins.
Why the study?
Sex differences in clinical outcomes for patients with T2DM could be related to sex disparities in treatment.
Are there sex disparities in medication prescribing amongst patients with type 2 diabetes mellitus managed in primary care?
Cohort (n=10,456)
Yes
Are there sex disparities in medication prescribing amongst patients with type 2 diabetes mellitus managed in primary care?
Odds Ratio: 0.7 (95% CI 0.61–0.8)
Absolute Event Rate: 81.7% vs 86.5%
Female patients with type 2 diabetes in primary care are significantly less likely to be prescribed guideline-directed therapies such as statins and RAAS inhibitors compared to males, which may contribute to worse cardiovascular and renal outcomes.
Sex-based disparities in T2D prescribing persist; leaves open whether these reflect bias or clinical factors, warranting prospective study.
BACKGROUND: Sex differences in clinical outcomes have been observed for patients with type 2 diabetes mellitus (T2DM). These could be related to sex disparities in treatment. OBJECTIVES: To determine whether there are sex disparities in medication prescribing amongst patients with T2DM. METHODS: A cohort study was conducted using the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) database, which includes data from primary care patients with T2DM from the north of the Netherlands. Data on demographics, physical examinations, laboratory measurements and prescribing were extracted. A set of validated prescribing quality indicators assessing the prevalence, start, intensification and safety of glucose-, lipid-, blood pressure- and albuminuria-lowering medication was applied for the calendar year 2019. Univariate logistic regression analyses were conducted. RESULTS: We included 10,456 patients (47% females). Females were less often treated with metformin (81.7% vs. 86.5%; OR 0.70, 95% CI 0.61-0.80), and were less often prescribed a renin-angiotensin-aldosterone inhibitor (RAAS-i) when treated with multiple blood pressure-lowering medicines (81.9% vs. 89.3%; OR 0.55, 95% CI 0.46-0.64) or when having albuminuria (74.7% vs. 82.1%; OR 0.64, 95% CI 0.49-0.85) than males. Statin treatment was less frequently started (19.7% vs. 24.7%; OR 0.75, 95% CI 0.58-0.96) and prescribed (58.7% vs. 63.9%; OR 0.80, 95% CI 0.73-0.89) in females. There were no differences in starting and intensifying glucose-, blood pressure- and albuminuria-lowering medication. CONCLUSIONS: Sex disparities in medication prescribing amongst T2DM patients were seen, including less starting with statins and potential undertreatment with RAAS-i in females. Such disparities may partly explain higher excess risks for cardiovascular and renal complications associated with diabetes observed in females.
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Ambrož et al. (2022) conducted a cohort in type 2 diabetes mellitus (n=10,456). Female sex vs. Male sex was evaluated on Treatment with metformin (OR 0.70, 95% CI 0.61-0.80). Female patients with type 2 diabetes were less likely to be treated with metformin than males (81.7% vs. 86.5%; OR 0.70, 95% CI 0.61-0.80), and had lower rates of RAAS-i and statin prescribing.
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