Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus.
Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus.
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DOI：
10.1210/er.2015-1137
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发表时间：
2016-06
影响因子：
20.3
通讯作者：
Pacini G
中科院分区：
文献类型：
--
作者：
Kautzky-Willer A;Harreiter J;Pacini G
2型糖尿病（T2DM）及其相关并发症的急剧上升伴随着越来越多的临床重要的性别差异的证据。2型糖尿病在年龄和体重指数较低的男性中更为常见；然而，最突出的风险因素是肥胖，这在女性中更为常见。一般来说，各国的性别比例差异很大。生物学、文化、生活方式、环境和社会经济地位的差异影响了男性和女性在易感性、发育和临床表现方面的差异。遗传效应和表观遗传机制、营养因素和久坐的生活方式对风险和并发症的影响在两性中是不同的。此外，性激素对能量代谢、身体组成、血管功能和炎症反应有很大的影响。因此，内分泌失衡与不利的心脏代谢特征有关，在雄激素过量的女性或性腺功能减退的男性中可以观察到。生理和社会心理因素都是造成糖尿病风险和结局的性别差异的原因。总的来说，社会心理压力对女性的影响似乎比对男性的影响更大。此外，与非糖尿病患者相比，女性患心血管疾病的风险、心肌梗死和中风的死亡率都比男性高。然而，当开始透析治疗时，男性和女性的死亡率是相当的。糖尿病似乎减弱了女性在心脏病和肾病发展中的保护作用。内分泌和行为因素涉及性别不平等并影响结果。更多关于2型糖尿病及其并发症的两性二态病理生理机制的研究，可能有助于未来更个性化的糖尿病护理，从而提高对性别和性别特异性危险因素的认识。
The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.