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Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis.

Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, Unwin N - PLoS ONE (2015)

Bottom Line: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes.Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.These findings have major implications for preventive policies and research.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.

ABSTRACT

Background: Diabetes (DM) is estimated to affect 10-15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender.

Methods: We searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models.

Results: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.

Conclusion and implications: Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.

No MeSH data available.


Related in: MedlinePlus

Relationship between gender and obesity.Only articles assessing obesity using an objective measure of body mass index (BMI) were included.
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pone.0126799.g004: Relationship between gender and obesity.Only articles assessing obesity using an objective measure of body mass index (BMI) were included.

Mentions: We examined the relationships between gender and various diabetes risk factors. There were 30 papers describing the relationship between gender and obesity as assessed by body mass index (BMI) from Jamaica (n = 7), Barbados (n = 6), Cuba (n = 6), Guadeloupe (n = 5), Suriname (n = 2), Puerto Rico (n = 2) Bahamas, Grenada, Saba and Trinidad (1 each)—3 papers covered both Cuba and Barbados (S2 Table). Studies that were population-based, measured body mass index by an objective standard protocol, adjusted for age or considered subjects in a narrow age range were assessed as having a low risk of bias. Men tended to have lower mean BMI values than women and this was true of all studies reporting this statistic in the adult population. Block et al [27] demonstrated that women in Grenada had higher mean BMI than men in each age group. Studies from Guadelope [47, 48]and Suriname[49] examined mean BMI in adolescent populations and found similar mean BMI values in girls and boys. Of the 16 articles from 13 unique studies which provided prevalence rates for obesity, 8 were population-based and measured obesity objectively (Table 3). These eight studies all found higher rates of obesity in women compared to men and when meta-analysed, provided an odds ratio in favour of women of 3.10 (95% CI 2.43, 3.94)(Fig 4). There were 18 articles that examined gender and abdominal obesity as measured using waist circumference and/or waist-to-hip ratio. Eight of these articles were assessed as having high risk of bias, while the remaining ten consistently reported higher rates of abdominal obesity in women compared to men.


Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis.

Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, Unwin N - PLoS ONE (2015)

Relationship between gender and obesity.Only articles assessing obesity using an objective measure of body mass index (BMI) were included.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440736&req=5

pone.0126799.g004: Relationship between gender and obesity.Only articles assessing obesity using an objective measure of body mass index (BMI) were included.
Mentions: We examined the relationships between gender and various diabetes risk factors. There were 30 papers describing the relationship between gender and obesity as assessed by body mass index (BMI) from Jamaica (n = 7), Barbados (n = 6), Cuba (n = 6), Guadeloupe (n = 5), Suriname (n = 2), Puerto Rico (n = 2) Bahamas, Grenada, Saba and Trinidad (1 each)—3 papers covered both Cuba and Barbados (S2 Table). Studies that were population-based, measured body mass index by an objective standard protocol, adjusted for age or considered subjects in a narrow age range were assessed as having a low risk of bias. Men tended to have lower mean BMI values than women and this was true of all studies reporting this statistic in the adult population. Block et al [27] demonstrated that women in Grenada had higher mean BMI than men in each age group. Studies from Guadelope [47, 48]and Suriname[49] examined mean BMI in adolescent populations and found similar mean BMI values in girls and boys. Of the 16 articles from 13 unique studies which provided prevalence rates for obesity, 8 were population-based and measured obesity objectively (Table 3). These eight studies all found higher rates of obesity in women compared to men and when meta-analysed, provided an odds ratio in favour of women of 3.10 (95% CI 2.43, 3.94)(Fig 4). There were 18 articles that examined gender and abdominal obesity as measured using waist circumference and/or waist-to-hip ratio. Eight of these articles were assessed as having high risk of bias, while the remaining ten consistently reported higher rates of abdominal obesity in women compared to men.

Bottom Line: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes.Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.These findings have major implications for preventive policies and research.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.

ABSTRACT

Background: Diabetes (DM) is estimated to affect 10-15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender.

Methods: We searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models.

Results: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.

Conclusion and implications: Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.

No MeSH data available.


Related in: MedlinePlus