Background: Evidence suggests sex-specific differences in the development and progression of diabetic nephropathy (DN). Men and women have been shown to respond differently to certain therapies and epidemiological data suggest underuse of statins and renin-angiotensin system (RAS) blocking agents in women. We evaluated our local practice to identify differences in clinical characteristics and prescribing between men and women with DN.
Methods: Clinical data were collected from electronic medical records and the Scottish national diabetes registry for patients who attended the diabetes renal clinic at Stobhill Hospital between January and April 2018.
Results: Data were available for 180 patients (age 65±12 years; 59% male). 33 patients (18%) had a diagnosis of type 1 diabetes while 142 (79%) had type 2 diabetes. Median diabetes duration was 18±9 years. Comparison between males and females showed that HbA1c (69±16 vs 69±22, P=0.730); blood pressure (SBP 140±19 vs 139±19, P=0.549); eGFR (38±21 vs 38±22 ml/min/1.73m2, P=0.991); and albumin: creatinine ratio (39 [0.5957] vs 13.3 [0.3805] mg/mmol, P=0.089) were not significantly different. Rates of type 1 diabetes were also similar between groups (19% men, 15% women). There were no differences in prescribing of statin (91 [86%] vs 60 [81%], P=0.197) or RAS blockade (67 [63%] vs 44 [60%], P=0.518) between men and women. However, despite higher BMI in women (34.5±7.6 vs 31.5±5.3 kg/m2, P=0.013) significantly fewer were on metformin (15 [20%] vs 37 [55%], P=0.029).
Conclusion: In our local population glycaemic control, blood pressure and renal parameters were similar between men and women with DN. In addition we saw no difference in prescribing of cardiovascular protective agents. However, despite higher BMI there are less women treated with metformin. The reasons for this are unclear and it remains to be seen whether prescribing patterns translate into different trajectories of DN progression between sexes.