CME Supplement

Managing Type 2 Diabetes in Men

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DISCLOSURES

Dr. Aguilar has disclosed that he has ongoing relationships with the following companies: Amylin Pharmaceuticals; Eli Lilly; Janssen Pharmaceuticals, Inc; Novo Nordisk, Inc; and Takeda Pharmaceuticals USA, Inc.

SUPPORT

This program is sponsored by the PCEC and is supported by funding from Novo Nordisk, Inc.

The prevalence of type 2 diabetes mellitus (T2DM) is similar in men and women (11.8% vs 10.8%, respectively), however there are gender differences that should be considered when developing a treatment plan (eg, cardiovascular risk, psychosocial factors, coping strategies, and the perception of benefit from self-care) when managing those diagnosed with this disease and those at risk for developing it.1 This article describes these differences in the context of two patients—one at risk for T2DM being seen by his health care provider for a routine physical examination, and one who has been treated for several years for T2DM and is being seen for a follow-up office visit. For each patient, the implications for treatment are discussed.

Men at Risk for Type 2 Diabetes Mellitus

JW is a 48-year-old white male being seen for a routine physical examination; he last saw a physician 6 years ago, also for a routine physical. He has no complaints and is taking no medications. Having divorced 7 years ago, he lives alone in an apartment and eats many of his meals at fast food restaurants. JW drinks 2 to 3 beers a night several times a week and more when he socializes with his friends 2 to 3 evenings per week. He smokes socially. His father has a 12-year history of T2DM. His mother has a 4-year history of essential hypertension and a 9-year history of chronic obstructive pulmonary disease.

Physical examination shows that JW is 5’11” tall, weighs 207 pounds (body mass index (BMI), 29 kg/m2), and has a 41” waist circumference; his blood pressure (BP) is 138/86 mm Hg and respiratory rate is 17 breaths/min. The remainder of his physical examination, including eye and neurologic exams, is normal. Laboratory results, including a screening glycated homoglobin (A1C), are pending.

Key Risk Factors for Type 2 Diabetes Mellitus in Men

This case is not an uncommon presentation of a middle-aged male who has several risk factors for diabetes (see Case Study 1 continued ). JW also has key risk factors for T2DM in men. The Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Augsburg surveys identified 128 men and 85 women with T2DM.2 Increasing age and BMI, positive parental history of T2DM, and a low high-density lipoprotein cholesterol (HDL-C) level were independent risk factors predicting the development of T2DM in both men and women. However, several other factors posed a higher risk in men relative to women, including systolic BP (hazard ratio [HR], 1.16 per 10-mm Hg increase), regular smoking (HR, 1.75), and alcohol intake ≥ 40 g/d (HR, 1.95). (Note: 1 fluid ounce 80 proof alcohol ≈ 11 g ethanol; 12 fluid ounces beer [~5% alcohol] ≈ 14 g ethanol). After adjusting for these factors, a separate analysis (4424 men, 4380 women) showed that men who lived alone were more likely to develop T2DM than either men or women who did not live alone (HR, 1.69 in men vs 0.85 in women; P = .006).3 While the number of people with T2DM in MONICA was small, the results suggest that measuring BP, particularly systolic BP, and taking a smoking and alcohol history may be especially important in men.

With respect to alcohol intake, epidemiologic and randomized clinical trials have generally demonstrated an inverse relationship between moderate alcohol consumption (20 to 30 g/d) and the long-term risk of T2DM.2,4-7 Differences among studies in how patients were grouped preclude determination of the daily alcohol consumption that confers the greatest risk benefit, although one recent study conducted over 4 years indicates that the greatest benefit in diabetes risk reduction may occur when men who previously consumed 8

Other nutrition and lifestyle patterns also seem to be particularly beneficial in reducing the risk of T2DM in men. Survey data involving 22,921 Japanese men and 29,759 Japanese women followed over 5 years showed that fish and seafood intake was significantly associated with a decreased risk of T2DM in men but not in women.9 The odds ratio of developing T2DM for the highest quartile versus the lowest quartile of fish and seafood intake was 0.73 (P = .04 for trend). Additional analysis did not identify any significant association with the fat content of fish.

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