|ISSN No. 1606-7754 Vol.15 No.3 December 2007|
EGender: does it have role has a role in glycaemic control in Caucasians with well-controlled type 2 diabetes?
Barre DE, Mizier-Barre KA, Griscti,O and Hafez, K
Department of Health Studies, Cape Breton University, Sydney, Nova Scotia, Canada
Background: Type 2 diabetes is costly to manage and thus it is important to know if management of blood glucose and HbA1c are meeting clinical targets in both men and women. There is conflicting published data on the gender equality of blood glucose and HbA1c management in type 2 diabetics. Objective: The purpose of this work was to review the literature on gender equality in blood glucose management and to test the hypothesis that management of blood glucose and HbA1c would meet clinical targets in Cape Breton, Nova Scotia, irrespective of gender in well controlled Caucasian type 2 diabetic patients. Design, Setting and Participants: Fasting serum insulin and insulin sensitivity levels were determined in order to assist in the explanation of the glucose and HbA1c results in people with diabetes. Patients were asked to give a fasting blood sample on each of two occasions three months apart. Results: There were no differences between males and females in each of fasting serum glucose (FSG) and HbA1c levels as well as fasting serum insulin concentrations and in insulin sensitivity at visit 1 or 2. However, each of FSG and HbA1c levels were slightly higher than clinical targets. Modestly elevated serum insulin and lower insulin sensitivity were consistent with the FSG and HbA1c levels. This contrasts with some of the existing literature pointing out the need for a much larger study to be done in Cape Breton. Conclusion: It is concluded that blood glucose management among people with well controlled type 2 diabetes in Cape Breton, Nova Scotia may be close to clinical targets irrespective of gender. A further lowering of HbA1c and FSG may be in order. However, this was only a very small study and a much larger one would answer whether there is gender equality in FSG and HbA1c among persons with well controlled type 2 diabetes on Cape Breton Island.
Key words: Diabetes mellitus, streptozotocin, voluntary exercise, heart muscle, ventricular myocytes
Cape Breton Island in the province of Nova Scotia, Canada suffers from among the highest rates of type 2 diabetes in Canada, the consequences of which are seen in the overall economy and in the competition for health care dollars with other health issues. Consequently it is important to control this disease as much as possible so as reduce its economic and social impact. There are no reports to date as regarding equity of management of glycaemia in type 2 diabetes by gender on Cape Breton Island, such information being of clear importance for the medical, economic and social impacts of this disease.
Type 2 diabetes is partially characterised by elevated fasting blood serum glucose (FSG) and insulin concentrations (in most cases), the percentage of haemoglobin as A1C (HbA1c) and decreased insulin sensitivity.1,2,3,4 Insulin insensitivity is frequently brought on by obesity or being overweight which results in a reduction in insulin receptor and post-insulin binding signalling transduction mechanisms.5,6,7,8 The response of the pancreas to insulin insensitivity is to increase the blood serum concentration of insulin.9,10,11 However this rise in insulin levels seldom compensates completely for the insulin insensitivity and consequently blood serum glucose concentrations rise.12,13,14,15 When blood serum glucose concentrations rise there is an increase in glycosylated HbA1c as there is an increased ratio to glucose to haemoglobin concentration thus allowing the glycosylation process to occur at a higher rate.16,17,18,19
The small body of existing literature on glycaemic control by gender presents conflicting views on whether there is equality among the sexes. Pouwer and Snoek,20 Pomerleau et al,21 Abdelmoneim and Al-Homrany,22 Nielsen et al,23 all report gender inequity in glycaemic control while Kobayashi et al.24 and Jonsson et al.25 Banerji et al26 showed no difference. Interestingly, assessment of glucose management by gender is also of interest to at least one other research group27 suggesting that this is a topic worthy of exploration. Thus, the results of glycaemic control by gender vary from study to study making this study critical. It is hypothesised that there is no difference in gender regarding glycaemic control in Caucasian type 2 diabetics on Cape Breton Island.
Type 2 diabetes is costly to manage and thus it is important to know if management of blood glucose and HbA1c meet clinical targets in both males and females. Presently there appear to be no studies addressing whether there are any gender differences in FSG, HbA1c, insulin or insulin sensitivity levels. The purpose of this work was to test the hypothesis that each of male and female patients with type 2 diabetes were meeting clinical targets in terms of each of fasting blood serum glucose and HbA1c. Hence it was also important to know if there are any gender-mediated differences in any of these parameters so as to decide which parameters might deserve more aggressive treatment in one sex over the other. Fasting blood serum insulin and insulin sensitivity levels were determined to assist in the explanation of the FSG and HbA1c results.