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Research article:
Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities
Reference:
Alison K. Wright, Evangelos Kontopantelis, Richard Emsley, Iain Edward Buchan, Mamas A. Mamas, Naveed Sattar, Darren M. Ashcroft, and Martin K. Rutter(2019) Cardiovascular Risk and Risk Factor Management in Type 2 Diabetes: A Population-Based Cohort Study Assessing Sex Disparities. Circulation, doi: 10.1161/CIRCULATIONAHA.118.039100
- Link to article
- Abstract
- Background: With recent changes in UK clinical practice for diabetes care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed. Methods: In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79,985 patients with incident T2DM between 2006-2013 matched to 386,547 patients without diabetes. Sex-stratified Cox models were used to assess cardiovascular risk. Results: Compared to women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted HR 1.20 [95% CI 1.12-1.28]) with similar corresponding data in men (HR 1.12 [1.06-1.19]) leading to a non-significant higher relative risk in women (risk ratio 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared to men with T2DM, women with T2DM were more likely to be obese, hypertensive and have hypercholesterolaemia but were less likely to be prescribed lipid-lowering medication and ACE inhibitors, especially if they had CVD. Conclusions: Compared to men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes care in women and men.
- Author for correspondence
- Alison Wright
- Email for correspondence
- alison.wright@manchester.ac.uk
Code list: res72: Interventions
172 codes in list
| Code | Coding system | Description | Entity type | List name | intervention_type | ||
|---|---|---|---|---|---|---|---|
| 03K1.00 | Read | Dietician | diagnostic | res72: Interventions | Diet | ||
| 138..00 | Read | Exercise grading | diagnostic | res72: Interventions | Exercise | ||
| 1383 | Read | Enjoys light exercise | diagnostic | res72: Interventions | Exercise | ||
| 1384 | Read | Enjoys moderate exercise | diagnostic | res72: Interventions | Exercise | ||
| 1385 | Read | Enjoys heavy exercise | diagnostic | res72: Interventions | Exercise | ||
| 1389 | Read | Aerobic exercise 1 time/week | diagnostic | res72: Interventions | Exercise | ||
| 138A.00 | Read | Aerobic exercise 2 times/week | diagnostic | res72: Interventions | Exercise | ||
| 138B.00 | Read | Aerobic exercise 3+ times/week | diagnostic | res72: Interventions | Exercise | ||
| 138D.00 | Read | Anaerobic exercise 1 time/week | diagnostic | res72: Interventions | Exercise | ||
| 138E.00 | Read | Anaerobic exercise 2 times/wk | diagnostic | res72: Interventions | Exercise | ||
| 138F.00 | Read | Anaerobic exercise 3+ times/wk | diagnostic | res72: Interventions | Exercise | ||
| 138G.00 | Read | Attends exercise classes | diagnostic | res72: Interventions | Exercise | ||
| 138H.00 | Read | Enjoys intermediate exercise | diagnostic | res72: Interventions | Exercise | ||
| 138P.00 | Read | Aerobic exercise three times a week | diagnostic | res72: Interventions | Exercise | ||
| 138Q.00 | Read | Aerobic exercise four times a week | diagnostic | res72: Interventions | Exercise | ||
| 138R.00 | Read | Aerobic exercise five times a week | diagnostic | res72: Interventions | Exercise | ||
| 138Z.00 | Read | Exercise grading NOS | diagnostic | res72: Interventions | Exercise | ||
| 13A..00 | Read | Diet - patient initiated | diagnostic | res72: Interventions | Diet | ||
| 13A3.00 | Read | Weight reducing diet | diagnostic | res72: Interventions | Diet | ||
| 13A4.00 | Read | Low fat diet | diagnostic | res72: Interventions | Diet | ||
| 13AB.00 | Read | Diabetic lipid lowering diet | diagnostic | res72: Interventions | Diet | ||
| 13AC.00 | Read | Diabetic weight reducing diet | diagnostic | res72: Interventions | Diet | ||
| 13AZ.00 | Read | Patient initiated diet NOS | diagnostic | res72: Interventions | Diet | ||
| 13B..00 | Read | Diet - medical | diagnostic | res72: Interventions | Diet | ||
| 13B1.00 | Read | Diabetic diet | diagnostic | res72: Interventions | Diet | ||
| 13B4.00 | Read | Lactose free diet | diagnostic | res72: Interventions | Diet | ||
| 13CQ.00 | Read | Physical activity target minimal exercise | diagnostic | res72: Interventions | Exercise | ||
| 13CR.00 | Read | Physical activity target light exercise | diagnostic | res72: Interventions | Exercise | ||
| 13CS.00 | Read | Physical activity target moderate exercise | diagnostic | res72: Interventions | Exercise | ||
| 13CT.00 | Read | Physical activity target strenuous exercise | diagnostic | res72: Interventions | Exercise | ||
| 1F11.00 | Read | Diet - low in fat | diagnostic | res72: Interventions | Diet | ||
| 1F7..00 | Read | Restricted diet pattern | diagnostic | res72: Interventions | Diet | ||
| 1F7Z.00 | Read | Dietary restriction NOS | diagnostic | res72: Interventions | Diet | ||
| 1FH..00 | Read | Healthy diet | diagnostic | res72: Interventions | Diet | ||
| 66A8.00 | Read | Has seen dietician - diabetes | diagnostic | res72: Interventions | Diet | ||
| 66At.00 | Read | Diabetic dietary review | diagnostic | res72: Interventions | Diet | ||
| 66At100 | Read | Type II diabetic dietary review | diagnostic | res72: Interventions | Diet | ||
| 66At111 | Read | Type 2 diabetic dietary review | diagnostic | res72: Interventions | Diet | ||
| 66AY.00 | Read | Diabetic diet - good compliance | diagnostic | res72: Interventions | Diet | ||
| 66C4.00 | Read | Has seen dietician - obesity | diagnostic | res72: Interventions | Diet | ||
| 6798 | Read | Health ed. - exercise | diagnostic | res72: Interventions | Exercise | ||
| 6799 | Read | Health ed. - diet | diagnostic | res72: Interventions | Diet | ||
| 679R.00 | Read | Patient offered diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 67H2.00 | Read | Lifestyle advice regarding exercise | diagnostic | res72: Interventions | Exercise | ||
| 67H7.00 | Read | Lifestyle advice regarding diet | diagnostic | res72: Interventions | Diet | ||
| 67W1.00 | Read | Recommendation self-refer for diabetes structured education | diagnostic | res72: Interventions | Diabetes education | ||
| 8581 | Read | Assisted exercise in pool | diagnostic | res72: Interventions | Exercise | ||
| 8582 | Read | Free exercises in pool | diagnostic | res72: Interventions | Exercise | ||
| 8B57.00 | Read | Weight reducing diet | diagnostic | res72: Interventions | Diet | ||
| 8B5A.00 | Read | Glycaemic index diet | diagnostic | res72: Interventions | Diet | ||
| 8B5C.00 | Read | Calorie restricted diet | diagnostic | res72: Interventions | Diet | ||
| 8B5C011 | Read | Very low calorie diet | diagnostic | res72: Interventions | Diet | ||
| 8B5C.11 | Read | Low calorie diet | diagnostic | res72: Interventions | Diet | ||
| 8B5Z.00 | Read | Dietary regime NOS | diagnostic | res72: Interventions | Diet | ||
| 8B91.00 | Read | Low carbohydrate diet -prophyl | diagnostic | res72: Interventions | Diet | ||
| 8B92.00 | Read | Low calorie diet - prophylaxis | diagnostic | res72: Interventions | Diet | ||
| 8B93.00 | Read | Low salt diet - prophylaxis | diagnostic | res72: Interventions | Diet | ||
| 8B94.00 | Read | Salt free diet - prophylaxis | diagnostic | res72: Interventions | Diet | ||
| 8B96.00 | Read | Unsaturated fat diet - prophyl | diagnostic | res72: Interventions | Diet | ||
| 8BAH.00 | Read | Exercise on prescription | diagnostic | res72: Interventions | Exercise | ||
| 8CA4.00 | Read | Patient advised re diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4000 | Read | Pt advised re wt reducing diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4100 | Read | Pt advised re diabetic diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4200 | Read | Pt advised re gluten free diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4600 | Read | Pt advised re low fat diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4700 | Read | Patient advised re low cholesterol diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4900 | Read | Pt advised - lactose free diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4A00 | Read | Pt advis-low carbohydrate diet | diagnostic | res72: Interventions | Diet | ||
| 8CA4V11 | Read | Dietary advice to maximise nutritional intake | diagnostic | res72: Interventions | Diet | ||
| 8CA4z00 | Read | Pt advised re diet NOS | diagnostic | res72: Interventions | Diet | ||
| 8CA5.00 | Read | Patient advised re exercise | diagnostic | res72: Interventions | Exercise | ||
| 8CA5000 | Read | Advice about aerobic exercise | diagnostic | res72: Interventions | Exercise | ||
| 8CA5200 | Read | Education about chair based exercise programme | diagnostic | res72: Interventions | Exercise | ||
| 8CE4.00 | Read | Diet leaflet given | diagnostic | res72: Interventions | Diet | ||
| 8E7..00 | Read | Physical exercises | diagnostic | res72: Interventions | Exercise | ||
| 8E71.00 | Read | Therapeutic exercise | diagnostic | res72: Interventions | Exercise | ||
| 8E72.00 | Read | Active exercise | diagnostic | res72: Interventions | Exercise | ||
| 8E79.00 | Read | Home exercise programme | diagnostic | res72: Interventions | Exercise | ||
| 8E7A.00 | Read | Group exercise programme | diagnostic | res72: Interventions | Exercise | ||
| 8E7B.00 | Read | Graded exercise therapy | diagnostic | res72: Interventions | Exercise | ||
| 8E7C.00 | Read | Aerobic exercises | diagnostic | res72: Interventions | Exercise | ||
| 8E7Z.00 | Read | Physical exercise NOS | diagnostic | res72: Interventions | Exercise | ||
| 8E8..00 | Read | Passive exercise | diagnostic | res72: Interventions | Exercise | ||
| 8E8Z.00 | Read | Passive exercise NOS | diagnostic | res72: Interventions | Exercise | ||
| 8H76.00 | Read | Refer to dietician | diagnostic | res72: Interventions | Diet | ||
| 8H76000 | Read | Referral to community dietician | diagnostic | res72: Interventions | Diet | ||
| 8H7q.00 | Read | Referral for exercise therapy | diagnostic | res72: Interventions | Exercise | ||
| 8H7q000 | Read | Referral for graded exercise therapy | diagnostic | res72: Interventions | Exercise | ||
| 8HgF.00 | Read | Discharge by dietitian | diagnostic | res72: Interventions | Diet | ||
| 8HgL.00 | Read | Discharge from dietetics service | diagnostic | res72: Interventions | Diet | ||
| 8HHc.00 | Read | Referred for exercise programme | diagnostic | res72: Interventions | Exercise | ||
| 8Hj0.00 | Read | Referral to diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 8Hj1.00 | Read | Family/carer referral to diabetes structured education prog | diagnostic | res72: Interventions | Diabetes education | ||
| 8Hj4.00 | Read | Referral to DESMOND diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 8Hj5.00 | Read | Referral to XPERT diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 8HkX.00 | Read | Referral to exercise on referral programme | diagnostic | res72: Interventions | Exercise | ||
| 8I81.00 | Read | Did not complete diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 8I84.00 | Read | Did not complete XPERT diabetes structured education program | diagnostic | res72: Interventions | Diabetes education | ||
| 9N0H.00 | Read | Seen in dietician clinic | diagnostic | res72: Interventions | Diet | ||
| 9N27.00 | Read | Seen by dietician | diagnostic | res72: Interventions | Diet | ||
| 9N6t.00 | Read | Referral by community-based dietitian | diagnostic | res72: Interventions | Diet | ||
| 9NiA.00 | Read | Did not attend diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 9NiD.00 | Read | Did not attend DESMOND diabetes structured education program | diagnostic | res72: Interventions | Diabetes education | ||
| 9NiE.00 | Read | Did not attend XPERT diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 9NJ6.00 | Read | In-house dietetics | diagnostic | res72: Interventions | Diet | ||
| 9NJh.00 | Read | In-house dietetics first appointment | diagnostic | res72: Interventions | Diet | ||
| 9NJi.00 | Read | In-house dietetics discharge appointment | diagnostic | res72: Interventions | Diet | ||
| 9NNF.00 | Read | Under care of dietitian | diagnostic | res72: Interventions | Diet | ||
| 9OLB.00 | Read | Attended diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLC.00 | Read | Family/carer attended diabetes structured education prog | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLF.00 | Read | Diabetes structured education programme completed | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLG.00 | Read | Attended XPERT diabetes structured education programme | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLK.00 | Read | DESMOND diabetes structured education programme completed | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLL.00 | Read | XPERT diabetes structured education programme completed | diagnostic | res72: Interventions | Diabetes education | ||
| 9OLM.00 | Read | Diabetes structured education programme declined | diagnostic | res72: Interventions | Diabetes education | ||
| Z65..00 | Read | Exercise therapy | diagnostic | res72: Interventions | Exercise | ||
| Z658.00 | Read | Aerobic exercises | diagnostic | res72: Interventions | Exercise | ||
| Z65B.00 | Read | Home exercise programme | diagnostic | res72: Interventions | Exercise | ||
| Z66..00 | Read | Exercise regime | diagnostic | res72: Interventions | Exercise | ||
| Z67..00 | Read | Exercise class | diagnostic | res72: Interventions | Exercise | ||
| Z67..11 | Read | Group exercise | diagnostic | res72: Interventions | Exercise | ||
| Z68..00 | Read | Exercises | diagnostic | res72: Interventions | Exercise | ||
| Z6D1.00 | Read | Hydrotherapy exercises | diagnostic | res72: Interventions | Exercise | ||
| Z6D3100 | Read | Aquaerobic exercises | diagnostic | res72: Interventions | Exercise | ||
| ZA11925 | Read | Advice on diet | diagnostic | res72: Interventions | Diet | ||
| ZC2..00 | Read | Dietary advice | diagnostic | res72: Interventions | Diet | ||
| ZC2..11 | Read | Advice on diet | diagnostic | res72: Interventions | Diet | ||
| ZC2..12 | Read | Advice about diet | diagnostic | res72: Interventions | Diet | ||
| ZC2C.00 | Read | Dietary advice for disorder | diagnostic | res72: Interventions | Diet | ||
| ZC2C100 | Read | Dietary treatment for disorder | diagnostic | res72: Interventions | Diet | ||
| ZC2C700 | Read | Patient advised about weight-reducing diet | diagnostic | res72: Interventions | Diet | ||
| ZC2C711 | Read | Dietary advice for weight reduction | diagnostic | res72: Interventions | Diet | ||
| ZC2C800 | Read | Dietary advice for diabetes mellitus | diagnostic | res72: Interventions | Diet | ||
| ZC2CA00 | Read | Dietary advice for type II diabetes | diagnostic | res72: Interventions | Diet | ||
| ZC2CI00 | Read | Dietary advice for lipid disorder | diagnostic | res72: Interventions | Diet | ||
| ZC2CJ00 | Read | Dietary advice for hyperlipidaemia | diagnostic | res72: Interventions | Diet | ||
| ZC2CM00 | Read | Dietary advice for obesity | diagnostic | res72: Interventions | Diet | ||
| ZC2CO00 | Read | Dietary advice for weight loss | diagnostic | res72: Interventions | Diet | ||
| ZC33.00 | Read | Dietary intake assessment using food models | diagnostic | res72: Interventions | Diet | ||
| ZC35.00 | Read | Dietary intake assessment using food diary | diagnostic | res72: Interventions | Diet | ||
| ZC36.00 | Read | Diet in ass usng food fr quest | diagnostic | res72: Interventions | Diet | ||
| ZC4..00 | Read | Dietary health promotion advice | diagnostic | res72: Interventions | Diet | ||
| ZG16.00 | Read | Advice about exercise | diagnostic | res72: Interventions | Exercise | ||
| ZG16100 | Read | Advice to exercise | diagnostic | res72: Interventions | Exercise | ||
| ZL45.00 | Read | Under care of dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL45100 | Read | Under care of community-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL45111 | Read | Under care of community dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL45200 | Read | Under care of hospital-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL45211 | Read | Under care of hospital dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82.00 | Read | Referral to dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82100 | Read | Referral to community-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82.11 | Read | Refer to dietician | diagnostic | res72: Interventions | Diet | ||
| ZL82111 | Read | Referral to community dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82.12 | Read | Refer to dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82200 | Read | Referral to hospital-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZL82211 | Read | Referral to hospital dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLDH.00 | Read | Discharge by dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLDH100 | Read | Discharge by hospital-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLDH111 | Read | Discharge by hospital dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLDH200 | Read | Discharge by community-based dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLDH211 | Read | Discharge by community dietitian | diagnostic | res72: Interventions | Diet | ||
| ZLEH.00 | Read | Discharge from dietetics service | diagnostic | res72: Interventions | Diet | ||
| ZLEH100 | Read | Discharge from hospital dietetics service | diagnostic | res72: Interventions | Diet | ||
| ZLEH200 | Read | Discharge from community dietetics service | diagnostic | res72: Interventions | Diet | ||
| ZRBB.11 | Read | DINE-Diet instr nutr educ ques | diagnostic | res72: Interventions | Diet | ||
| ZV65300 | Read | [V]Dietary surveillance and counselling | diagnostic | res72: Interventions | Diet | ||
| ZV65312 | Read | [V]Dietary counselling in diabetes mellitus | diagnostic | res72: Interventions | Diet | ||
| ZV65313 | Read | [V]Dietary counselling | diagnostic | res72: Interventions | Diet | ||
| ZV65314 | Read | [V]Dietary surveillance | diagnostic | res72: Interventions | Diet | ||
| ZV65317 | Read | [V]Dietary surveillance in hypercholesterolaemia | diagnostic | res72: Interventions | Diet | ||
| ZV65318 | Read | [V]Dietary counselling in hypoglycaemia | diagnostic | res72: Interventions | Diet | ||
| ZV65319 | Read | [V]Dietary counselling in obesity | diagnostic | res72: Interventions | Diet |
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