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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.
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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; Barrett-Connor, 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)
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