Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes

A cross-sectional observational study from the AMD Annals initiative

  1. on behalf of the AMD Annals Study Group*
  1. 1Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Chieti, Abruzzo, Italy
  2. 2Diabetes and Endocrinology Unit, Cardarelli Hospital, Campobasso, Italy
  3. 3Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
  4. 4Unit of Internal Medicine, Montecchio Hospital, Montecchio Emilia (RE), Emilia-Romagna, Italy
  5. 5Diabetes and Metabolic Diseases Unit, San Martino Hospital, Oristano, Italy
  6. 6Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy
  7. 7Diabetes and Metabolism Unit, Sandro Pertini Hospital, Rome, Italy
  8. 8Diabetes and Metabolism Unit, ASL TO5, Chieri (TO), Turin, Piedmont, Italy
  1. Corresponding author: Maria Chiara Rossi, mrossi{at}


OBJECTIVE To investigate the quality of type 2 diabetes care according to sex.

RESEARCH DESIGN AND METHODS Clinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated.

RESULTS Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c >9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10–1.17]), 42% more likely to have LDL cholesterol (LDL-C) ≥130 mg/dL (1.42 [1.38–1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 kg/m2 (1.50 [1.50–1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure.

CONCLUSIONS Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.


  • * A complete list of the members of the AMD Annals Study Group can be found in the Supplementary Data online.

  • Received January 22, 2013.
  • Accepted April 29, 2013.

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This Article

  1. Diabetes Care
  1. Supplementary Data
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