Medicine has made life-saving advances in treating and preventing heart disease, the major killer of people with diabetes, yet female diabetics are dying at higher rates than three decades ago, researchers reported this week.
"There's good news here; we are making progress," said Dr. Deborah Burnet, a diabetes expert at the University of Chicago. "The bad news is it appears to be limited to men."
The trend has ominous public-health consequences, experts note. Diabetes is growing more common in the U.S. as the population gets older and fatter, and elderly women are the fastest-growing segment of society.
The new study, published online in the Annals of Internal Medicine, found that in 2000 the mortality rate for female diabetics was 25.9 per 1,000 women per year, a rate significantly higher than in the 1980s and '90s. Meanwhile, the death rate for diabetic men decreased.
In addition, while having diabetes more than doubled a man's risk of dying of cardiovascular disease, it more than quadrupled the risk for women. Female diabetics were dying of heart disease at the rate of 9.4 per 1,000, compared with 2.3 for women without diabetes.
"A diabetic woman is at the same risk for heart attack as a woman who has already had one," said Dr. Nanette Wenger of Emory University in Atlanta, who wrote an editorial accompanying the study.
The study was not designed to explain the differences. But Wenger suggested that women with diabetes and heart disease are less likely to get appropriate care, such as cholesterol-lowering drugs.
Dr. Larry Deeb, president of the American Diabetes Association, speculated that part of the explanation may lie in the persistent misconception that heart disease is a man's problem.
"We were aggressive in men," he said. "We made them take aspirin, we made them exercise, we checked their blood pressure and cholesterol -- and it paid off. ... We have medicines that work. Maybe we haven't been giving them to women."
Deeb said women should insist on the very best control of known risk factors. "Don't accept that your blood sugar is 10 or 15 percent too high," he said. "Don't accept that your blood pressure is almost controlled. Don't accept that your cholesterol is almost low enough. You want your numbers to be as good as they can get."
Experts agree doctors must realize that diabetic women are at extremely high risk of developing heart disease and must work aggressively to manage their risk factors -- not just their blood sugar but also their cholesterol, blood pressure, smoking, obesity and lack of exercise.
Judy Peres writes for the Chicago Tribune.