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Letter to the Editor| Volume 197, 110556, March 2023

Re: Diabetes mellitus is associated with a higher relative risk for venous thromboembolism in females than in males

Published:February 02, 2023DOI:https://doi.org/10.1016/j.diabres.2023.110556
Re: Diabetes mellitus is associated with a higher relative risk for venous thromboembolism in females than in males
Previous ArticleFinnish children carrying the high-risk HLA genotype have a 45-fold increased risk of type 1 diabetes compared to peers with neutral or protective genotypes
      Deischinger et al [
      • Deischinger C.
      • Dervic E.
      • Nopp S.
      • Kaleta M.
      • Klimek P.
      • Kautzky-Willer A.
      Diabetes mellitus is associated with a higher relative risk for venous thromboembolism in females than in males.
      Diabetes Res Clin Pract. 2022 Dec; 194110190https://doi.org/10.1016/j.diabres.2022.110190
      ] have shown that diabetes is associated with 1.4-fold greater risk of venous thromboembolism (VTE) and that the risk in females was greater than for men. An acknowledged limitation in this study was that they were unable to differentiate type 1 and type 2 diabetes mellitus [
      • Hinton W.
      • Nemeth B.
      • de Lusignan S.
      • Field B.
      • Feher M.D.
      • Munro N.
      • et al.
      Effect of type 1 diabetes and type 2 diabetes on the risk of venous thromboembolism.
      Diabet Med. 2021 May; 38 (Epub 2020 Nov 27): e14452
      ,
      • Peng Y.H.
      • Lin Y.S.
      • Chen C.H.
      • Tsai K.Y.
      • Hung Y.C.
      • Chen H.J.
      • et al.
      Type 1 diabetes is associated with an increased risk of venous thromboembolism: A retrospective population-based cohort study.
      PLoS One. 2020; 15: e0226997
      ]. We recently reported that the unadjusted risk for VTE in type 1 diabetes (T1D) was lower than for type 2 diabetes (T2D). However, after adjustment for sex, age, and contraception or hormone replacement therapy (HRT) use, the risk of VTE was increased in T1D (HR 1.46, 95% CI 1.11–1.92), but not with T2D (hazard ratio 1.06, 95% confidence interval 0.98–1.14). This goes against the historic view that T2D carried a greater risk, possibly underpinned by insulin resistance [
      • Grant P.J.
      Diabetes mellitus as a prothrombotic condition.
      J Intern Med. 2007; 262: 157-172
      ,
      • Van Schouwenburg I.M.
      • Mahmoodi B.K.
      • Veeger N.J.
      • Bakker S.J.
      • Kluin-Nelemans H.C.
      • Meijer K.
      • et al.
      Insulin resistance and risk of venous thromboembolism: results of a population-based cohort study.
      J Thromb Haemost. 2012; 10: 1012-1018
      ]. Previous studies have shown sex differences in VTE risk with females having a two- to threefold higher risk of a first VTE during potential childbearing years attributed to hormonal factors such as contraceptive use and pregnancy. VTE associated with pregnancy has distinct ICD-10 codes (O22, O87) which were not included in this study and this may have led to under-estimation of any potential sex difference in younger adults [
      • Scheres L.J.J.
      • van Hylckama V.A.
      • Cannegieter S.C.
      Sex-specific aspects of venous thromboembolism: What is new and what is next?.
      Res Pract Thromb Haemost. 2022 May 23; 6: e12722
      ].
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      References

        • Deischinger C.
        • Dervic E.
        • Nopp S.
        • Kaleta M.
        • Klimek P.
        • Kautzky-Willer A.
        Diabetes mellitus is associated with a higher relative risk for venous thromboembolism in females than in males.
        Diabetes Res Clin Pract. 2022 Dec; 194110190https://doi.org/10.1016/j.diabres.2022.110190
        View in Article
        • Hinton W.
        • Nemeth B.
        • de Lusignan S.
        • Field B.
        • Feher M.D.
        • Munro N.
        • et al.
        Effect of type 1 diabetes and type 2 diabetes on the risk of venous thromboembolism.
        Diabet Med. 2021 May; 38 (Epub 2020 Nov 27): e14452
        View in Article
        • Peng Y.H.
        • Lin Y.S.
        • Chen C.H.
        • Tsai K.Y.
        • Hung Y.C.
        • Chen H.J.
        • et al.
        Type 1 diabetes is associated with an increased risk of venous thromboembolism: A retrospective population-based cohort study.
        PLoS One. 2020; 15: e0226997
        View in Article
        • Grant P.J.
        Diabetes mellitus as a prothrombotic condition.
        J Intern Med. 2007; 262: 157-172
        View in Article
        • Van Schouwenburg I.M.
        • Mahmoodi B.K.
        • Veeger N.J.
        • Bakker S.J.
        • Kluin-Nelemans H.C.
        • Meijer K.
        • et al.
        Insulin resistance and risk of venous thromboembolism: results of a population-based cohort study.
        J Thromb Haemost. 2012; 10: 1012-1018
        View in Article
        • Scheres L.J.J.
        • van Hylckama V.A.
        • Cannegieter S.C.
        Sex-specific aspects of venous thromboembolism: What is new and what is next?.
        Res Pract Thromb Haemost. 2022 May 23; 6: e12722
        View in Article
        • American Diabetes Association
        Hospital Admission Guidelines for Diabetes.
        Diabetes Care. 2004 Jan; 27: S103https://doi.org/10.2337/diacare.27.2007.s103)
        View in Article

      Article info

      Publication history

      Published online: February 02, 2023
      Accepted: January 27, 2023
      Received: January 23, 2023

      Identification

      DOI: https://doi.org/10.1016/j.diabres.2023.110556

      Copyright

      © 2023 Elsevier B.V. All rights reserved.

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