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Type 2 diabetes is a relatively common lifelong condition which increases the risk of several diseases, such as cardiovascular disease and kidney disease. It is often managed by achieving a target level of glycated haemoglobin A1c (HbA1c), which gives an assessment of the level of blood sugar over the last three months. However, HbA1c is not only a measure of blood sugar; it is also affected by other factors, such as iron levels.
Men generally have higher iron than women. At the same level of HbA1c, men on average have higher blood sugar than women, meaning that the same HbA1c target represents higher levels of blood sugar in men than women.
To investigate whether this difference in management has real world consequences, CUNY SPH Professor Mary Schooling and colleagues led a study published in eBio Medicine. To mimic a randomized controlled trial, the researchers examined the effect of genetic predictors of HbA1c on a measure of lifespan. The study confirmed that, at the same level of HbA1c, men had higher fasting glucose than women, which may result in HbA1c and diabetes reducing lifespan more in men than women. As such, the study contributes to explaining shorter lives in general in men than women and suggests that sex-specific HbA1c targets in type 2 diabetes might lead to more equitable management.
“Management of type 2 diabetes using HbA1c should consider taking iron levels into account to promote equity of outcomes,” says Dr. Schooling.
