Gender-Related Differences in Hypoglycemia with Glucose-Lowering Treatment

New Orleans—Treatment recommendations for lowering glucose vary by chronic kidney disease (CKD) stage. Despite possible differences in efficacy, there are no differences in treatment recommendations by gender, raising the possibility of differences in glucose control and hypoglycemia by gender.

In a French study conducted by Marie Metzger, MD, and colleagues, 3033 patients with CKD stages 3 to 5 were recruited; of those, 645 men and 288 women were treated with glucose lowering drugs. Uncontrolled glucose was defined by hemoglobin A1c (HbA1c) ≥7%; hypoglycemia was defined by self-report. Dr. Metzger reported study results during a poster session at Kidney Week 2017 in a poster titled Impact of Gender on the Patterns of Glucose-Lowering Treatment and Hypoglycemia in Patients with Type 2 Diabetes and Advanced CKD: The French CKD-REIN Study.

Fifty-five percent of men were treated with insulin; 65% of women were treated with insulin. Insulin treatment was more common in patients with later stages of CKD. At lower CKD stages, fewer women than men were treated with insulin. Overall, 31% were treated with insulin only, 28% were treated with a combination regimen of insulin and another drug, and 42% were treated with non-insulin glucose lowering drugs.

The prevalence of uncontrolled glucose was 57%. In a multivariable model, there were associations between insulin treatment and longer duration of diabetes and higher body mass index (BMI). There were no associations between insulin treatment and gender, age, or estimated glomerular filtration rate (eGFR).

Forty percent of men and 59% of women reported hypoglycemia; there was no relationship between hypoglycemia and eGFR or HbA1c. Following adjustment for age, sex, BMI, and duration of diabetes, reports of hypoglycemia were more frequent among people treated with insulin.

In summary, the researchers said, “In people with diabetes and CKD, HbA1c, CKD stage, and reported hypoglycemia were not associated. However, glucose-lowering treatment and hypoglycemia, but not glucose control, were gender dependent; this seems to be related to insulin treatment which may need to be adapted to avoid hypoglycemia, especially in women.”

Source: Metzger M, Balkau B, Frimat L, et al. Impact of gender on the pattern of glucose-lowering treatment and hypoglycemia in patients with type 2 diabetes and advanced CKD: The French CKD-REIN study. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 2, 2107, New Orleans, Louisiana.