Sex-based disparities in diabetes care in children with type 1 diabetes were identified and may be linked to differences in outcomes between male and female adult patients, according to a systematic review and meta-analysis published in Diabetologia.
“Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known,” the study authors wrote.
Researchers sought to identify differences in pediatric diabetes care based on patient sex and to assess whether these differences were associated with treatment outcomes or complications.
The investigators conducted a literature review through June 15, 2021, and identified 90 studies for their analysis. The total population comprised 643,217 individuals. Studies were of observational design and comprised cohort, cross-sectional, and case-control studies.
Sex-Based Differences in Pediatric Diabetes
Seven studies, comprising 22,089 patients, showed a higher HbA1c in young female children at diagnosis, and 20 studies, comprising 144,613 patients, found higher HbA1c in females during treatment. Female patients also had a steeper HbA1c increase over time. Being female was also associated with higher body mass index (BMI), higher prevalence of being overweight/obese, and higher prevalence of dyslipidemia. According to 6 studies (n=211,347), female patients required pump therapy more often and higher insulin doses.
Several comorbidities were also more prevalent in female patients, including thyroid and celiac disease. Of 15 studies reporting on quality of life, all 15 (n=8,722) reported a lower quality of life among female patients than males.
The authors noted several limitations of their study. “Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted,” they wrote. “The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes.”
The authors summarized, “Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes.”