Girls with type 1 diabetes are more likely to face a harder time controlling their blood sugar, be hospitalised with serious complications, have higher insulin doses, and report a lower overall quality of life, especially during adolescence.
New research suggests that girls with type 1 diabetes (T1DM) have worse metabolic control and are more likely to have complications than boys.
Silvia de Vries from Amsterdam University Medical Centers in the Netherlands and colleagues conducted a systematic analysis that gathered all the evidence on the gender differences in the care and outcomes of children and adolescents (aged 18 or younger).
De Vries says that making young women more aware of type 1 diabetes is the key to reducing differences in care and lowering the risk of life-threatening complications like heart disease and kidney failure later in life.
There are around 1.1 million children and adolescents living with type 1 diabetes around the world. This makes type 1 diabetes the most prevalent chronic disease affecting children. People with T1DM have an immune system that mistakenly attacks cells in the pancreas that make insulin.
This means that the body makes little or no insulin and blood sugar levels rise to dangerously high levels. People with T1DM have to take insulin shots every day for the rest of their lives to stay alive.
T1DM is especially dangerous because it is often not found until severe, sometimes life-threatening symptoms appear. Long-term complications include renal failure, heart attacks, strokes, nerve damage, blindness, vascular problems, and decreased life expectancy are more likely to occur when the condition is diagnosed earlier in life and has been present for a longer period of time.
Cardiovascular care and outcomes for adults with T1DM are different for men and women. When compared to males with T1DM, women with T1DM have an excess risk of death from any cause that is around 40% higher and an excess risk of both fatal and nonfatal vascular events that is twice as high. But it is not known if sex affects how children are cared for or how well they do in life.
De Vries and colleagues conducted a comprehensive analysis of observational studies from all over the world up to June 2021 to examine sex differences in T1DM patients and disease characteristics, therapy, comorbidities, and complications in children (aged 18 or younger). 90 papers reporting on significant outcomes related to the daily care process were included in the review out of the 8,640 publications that were found.
7 out of 10 studies that looked at 89,700 children found that girls had a higher body mass index (BMI) than boys. Results were the same for adolescent girls (7 studies, 33,153 children): more girls than boys were overweight or obese, and girls also had higher levels of dyslipidaemia (unhealthy levels of cholesterol or other lipids in the blood).
Similar results were seen in studies concentrating on blood sugar control, one of the most significant markers for long-term problems. Girls during treatment had average blood sugar (Haemoglobin A1c) levels that were up to 6.4 mmol/mol higher (21 studies including 144,613 young people). This distinction was also observed at the time of diagnosis and in investigations documenting a rise in mean blood sugar over time.
Also, girls were more likely to use insulin pump therapy (6 studies, 211,324 young people) and needed higher insulin doses.
Young females were more likely to have diabetes-related comorbidities such thyroid and celiac disease.
It’s not clear why metabolic control is different between girls and boys, but some evidence suggests that normal changes in girls’ bodies during puberty make it harder for them to control their diabetes.
But some differences seem to be there before puberty. These differences may be caused by differences in body composition and fat distribution that happen before puberty. It’s also possible that pre-adolescent gender differences in behaviour play a role.
When looking at the serious complication of diabetic ketoacidosis (DKA) in 8 studies with a total of 3,561 young people, the results were the same with DKA at diagnosis. Girls were more likely to experience DKA during therapy as well as more severe DKA that required hospitalization.
Diabetic ketoacidosis happens when a person doesn’t take enough insulin medicine or gets sick, which causes too much sugar in the blood and a dangerous buildup of acid in the blood. When DKA is severe, it may necessitate hospitalisation for fluid replacement and insulin therapy, and it may even result in death or a diabetic coma.
According to the authors, the greater prevalence of DKA upon diagnosis may indicate that gender disparities exist even in the earliest stages of the illness. The way a disease develops and how its initial symptoms are presented can differ between the sexes. It is necessary to resolve any discrepancies in how the treatment team and caregivers interpret those initial symptoms.
On the other hand, other investigations revealed that partial diabetes remission and hypoglycaemia (hypos; low blood sugar level) occurred more frequently in boys.
After looking at data from 15 studies with 8,722 children and teens, it was found that all of the studies showed that adolescent girls have a lower overall quality of life. Girls were shown to be at especially high risk for experiencing distress from their diabetes and fear of hypos.
To enhance glycemic control and lower the risk of complications, De Vries thinks it may be necessary to improve disease-related coping skills and quality of life during this vulnerable time. All young individuals with type 1 diabetes should receive care that is personalised for them in order to help them properly control their condition.
All young individuals with type 1 diabetes should receive care that is personalised for them in order to help them properly control their condition.
All of these studies were observational, and the authors admit that it is impossible to draw any firm conclusions about a cause-and-effect relationship between sex and the outcomes they looked at. They also say that their goal was to find out if there were any differences in how children with diabetes are treated based on their gender. This could have led to a lack of studies with neutral results, which could make it harder to draw a conclusion.
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