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: 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)

Patient Characteristics: PRP Sample Patient Characteristics Males (n=3368) Females (n=3996)P-value Mean age NS % some college <.001 Health rating NS % on insulin NS

Patient Characteristics: Kaiser Sample Patient Characteristics Males (n=7394) Females (n=7277)P-value Mean age NS Percent minority <.001 Mean BMI NS % on insulin NS

Patient Characteristics: UCI Sample Patient Characteristics Males (n=61) Females (n=106)P-value Mean age NS % some college <.001 Health rating NS

Gender Differences in Lipid Monitoring and Control Quality Measure Sample MalesFemalesP-value Monitoring lipidsPRP NS LDL < 100mg/dl <.001 Monitoring lipidsKPG NS LDL < 100mg/dl <.001 Monitoring lipidsUCI100 NS LDL < 100mg/dl <.001

Gender differences in overall quality of diabetes care: PRP Quality MeasureMalesFemalesP-value Annual HbA1c NS Annual urine protein NS Annual eye exam NS Annual foot exam NS HbA1c < 8 mg/dl NS BP <130/ NS

Gender differences in overall quality of diabetes care: KPG Quality MeasureMalesFemalesP-value Annual HbA1c <.001 Annual blood pressure <.01 HbA1c < 8 mg/dl <.001 BP <130/ NS

Gender differences in overall quality of diabetes care: UCI Quality MeasureMalesFemalesP-value Annual HbA1c100 NS Annual foot exam <.01 HbA1c < 8 mg/dl <.001 BP <130/ NS

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