Sex differences in rates of change and burden of metabolic risk factors among adults who did and did not go on develop diabetes: two decades of follow-up from the Tehran Lipid and Glucose study

Objective: We investigated the cumulative burden and linear rates of change of major metabolic risk factors (MRFs) among Iranian adults in whom type 2 diabetes did and did not develop.

Research Design and Methods: We included 7,163 participants (3,069 men) aged 20-70 years at baseline with at least three examinations during 1999-2018. Individual growth curve modeling was used for data analysis. Statistical interactions for sex by diabetes status were adjusted for age, family history of diabetes, smoking status and physical activity level.

Results: Study sample included 743 (316 men) new cases of diabetes. In both men and women, compared with individuals in whom diabetes did not develop, individuals in whom diabetes developed had a higher burden of all MRFs and a greater rate of change in body mass index (BMI), fasting plasma glucose (FPG), systolic and diastolic blood pressure (SBP and DBP); however, the differences in burden and rate of change between those who did and did not develop diabetes were greater in women than in men. So that, during the transition to diabetes, women experienced more adverse change in BMI, FPG, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) (diabetes-sex interaction P values <0.05), and faster rates of change in BMI, FPG, HDL-C and total cholesterol (TC) (interaction P values <0.01) and SBP (interaction P=0.055) than men.

Conclusion: The greater exposure of women to and burden of MRFs before onset of diabetes may have implications for implementing sex specific strategies in order to prevent or delay diabetes complications.