Sex differences in the incidence of complications among people with diabetes in a South Indian population: 12 years follow up of CURES study (CURES-159)

Background & objectives Little data exist on population-based incidence of diabetes related complications in developing countries. We assessed sex-specific incidence of complications among Asian Indians with type 2 diabetes (T2D) based on follow up assessments from a community-based cohort. Methods We evaluated incident complications among individuals with T2D identified in the Chennai urban rural epidemiological study (CURES) conducted in 2001-03, who were complication-free at baseline and re-assessed once during a follow up survey in 2012-14. Diabetic retinopathy was assessed using retinal photography, diabetic peripheral neuropathy using biothesiometry, diabetic kidney disease using urinary albumin excretion and estimated glomerular filtration rate (eGFR), peripheral artery disease by ankle-brachial index, and coronary artery disease using medical history of coronary artery disease and/or Minnesota coding of ECGs. Cumulative incidence reflected the proportion developing each complication during a specified period of time, and relative risk analysis identified associated risk factors. Results Among 1,053 participants [men= 453(43%)], assessed in a cross-sectional manner about a decade later, the cumulative incidence rates differed by sex: women showed higher rates of diabetes kidney disease (36.1 vs. 31.4%) and peripheral artery disease (35.4 vs. 23.9%) whereas men had higher rates of diabetic retinopathy (37.0 vs. 27.3%) and coronary artery disease (36.2 vs. 34.5%). The incidence of peripheral neuropathy was comparable between men (63%) and women (62.7%). After adjusting for confounding variables compared to men, women had higher risk for peripheral artery disease [range (RR:1.62, 95% confidence interval (CI):1.20-2.17] but a lower risk for diabetic retinopathy (RR:0.75,95% CI:0.59-0.97) and coronary artery disease (RR:0.60, 95% CI:0.49-0.75). Interpretation & conclusions Women have a higher risk of peripheral arterial disease and lower risk of diabetic retinopathy and coronary artery disease, while there were no sex differences for developing kidney disease and peripheral neuropathy.