TY - JOUR
T1 - Do sex differences in paediatric type 1 diabetes care exist? A systematic review
AU - de Vries, Silvia A. G.
AU - Verheugt, Carianne L.
AU - Mul, Dick
AU - Nieuwdorp, Max
AU - Sas, Theo C. J.
N1 - Funding Information: Some of the data were presented as an abstract at the 58th Annual Meeting of the EASD in 2022. The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work. SAGdV, CLV and TCJS designed the study and created the search strategy. The literature was searched and data was extracted and screened by SAGdV. Abstracts and full-text articles were assessed in duplicate by SAGdV and CLV. SAGdV wrote the manuscript. CLV and TCJS were project lead and advised on the review methodology, time-lines of the project and revised the manuscript. DM participated in the study design and critically revised the manuscript. MN was overall project lead, participated in the study design and advised on the progress of the project. All authors contributed to the study design, revised and approved the final manuscript. SAGdV is responsible for the integrity of the work as a whole. Publisher Copyright: © 2023, The Author(s).
PY - 2023/4
Y1 - 2023/4
N2 - Aims/hypothesis: 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. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. Methods: Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. Results: A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case?control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. Conclusions/interpretation: 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. Registration: This systematic review is registered in PROSPERO (CRD42020213640) Graphical abstract: [Figure not available: see fulltext.].
AB - Aims/hypothesis: 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. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. Methods: Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. Results: A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case?control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. Conclusions/interpretation: 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. Registration: This systematic review is registered in PROSPERO (CRD42020213640) Graphical abstract: [Figure not available: see fulltext.].
KW - Child
KW - Diabetes mellitus
KW - Narrative synthesis
KW - Sex differences
KW - Systematic review
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85146852631&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00125-022-05866-4
DO - https://doi.org/10.1007/s00125-022-05866-4
M3 - Review article
C2 - 36700969
SN - 0012-186X
VL - 66
SP - 618
EP - 630
JO - Diabetologia
JF - Diabetologia
IS - 4
ER -