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Gender-differences in glycemic control and diabetes related factors in young adults with type 1 diabetes: results from the METRO study



To describe gender differences concerning glycemic control, cardiovascular risk factors, diabetic complications, concomitant pathologies, and circulating endothelial progenitor cells (EPCs), in a population of young adults with type 1 diabetes.


We collected data from 300 consecutively patients (168 males and 132 females), aged 18–30 years, among those admitted at Diabetes Unit of University of Campania “Luigi Vanvitelli” (Naples, Italy) from March 2012 to January 2017. Circulating levels of seven EPCs phenotypes were determined by flow cytometry.


As compared to men, women with type 1 diabetes had a significantly higher HbA1c levels (%, 8.4 ± 1.3 vs. 8.1 ± 1.3, P = 0.020), body mass index (Kg/m2, 24.8 ± 4.2 vs. 23.9 ± 3.9, P = 0.034), HDL-cholesterol (mg/dL, 61.7 ± 13.7 vs. 54.7 ± 13.9, P < 0.001), and a lower count of both CD133+KDR+ and CD34+KDR+CD133+ EPCs (P = 0.022, P < 0.001, respectively). A higher proportion of women had overweight/obesity, and thyroiditis; smoking and sexual dysfunctions were more prevalent in men than in women.


Young adults with type 1 diabetes present gender differences with regard to glycemic control, prevalence of some cardiovascular risk factors, sexual dysfunctions and circulating levels of EPCs, most often to the detriment of women.

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  1. 1.

    M.A. Atkinson, G.S. Eisenbarth, A.W. Michels, Type 1 diabetes. Lancet 383, 69–82 (2014)

    Article  PubMed  Google Scholar 

  2. 2.

    International Diabetes Federation. IDF Diabetes Atlas. 7th edn. (International Diabetes Federation, Brussels, 2015)

    Google Scholar 

  3. 3.

    E.J. Mayer-Davis, J.M. Lawrence, D. Dabelea, J. Divers, S. Isom, L. Dolan, G. Imperatore, B. Linder, S. Marcovina, D.J. Pettitti, C. Pihoker, S. Saydah, L. Wagenknecht, and SEARCH for Diabetes in Youth Study Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. N. Engl. J. Med. 376, 1419–1429 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    A. Rawshani, A. Rawshani, S. Franzén, B. Eliasson, A.M. Svensson, M. Miftaraj, D.K. McGuire, N. Sattar, A. Rosengren, S. Gudbjörnsdottir, Mortality and cardiovascular disease in type 1 and type 2 diabetes. N. Engl. J. Med. 376, 1407–1418 (2017)

    Article  PubMed  Google Scholar 

  5. 5.

    M.I. Maiorino, G. Bellastella, M. Petrizzo, M.R. Improta, C. Brancario, F. Castaldo, L. Olita, D. Giugliano, K. Esposito, Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI. Endocrine 46, 256–262 (2014)

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    K.M. Miller, N.C. Foster, R.W. Beck, R.M. Bergenstal, S.N. DuBose, L.A. DiMeglio, D.M. Maahs, W.V. Tamborlane, T1D exchange clinic network: current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care 38, 971–978 (2015)

    Article  PubMed  Google Scholar 

  7. 7.

    Diabetes Control and Complications Trial Research Group, D.M. Nathan, S. Genuth, J. Lachin, P. Cleary, O. Crofford, M. Davis, L. Rand, C. Siebert, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329, 977–986 (1993)

    Article  Google Scholar 

  8. 8.

    K.S. Bryden, D.B. Dunger, R.A. Mayou, R.C. Peveler, H.A. Neil, Poor prognosis of young adults with type 1 diabetes: a longitudinal study. Diabetes Care 26, 1052–1057 (2003)

    Article  PubMed  Google Scholar 

  9. 9.

    A. Peters, L. Laffel, and American Diabetes Association Transitions Working Group, Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care. 34, 2477–2485 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    D.B. Petitti, G.J. Klingensmith, R.A. Bell, J.S. Andrews, D. Dabelea, G. Imperatore, S. Marcovina, C. Pihoker, D. Standiford, B. Waitzfelder, E. Mayer-Davis, and SEARCH for Diabetes in Youth Study Group, Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study. J. Pediatr. 155, 668–672 (2009)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. 11.

    K.O. Schwab, J. Doerfer, W. Hecker, J. Grulich-Henn, D. Wiemann, O. Kordonouri, P. Beyer, R.W. Holl, and DPV Initiative of the German Working Group for Pediatric Diabetology Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care 29, 218–225 (2006).

    Article  PubMed  Google Scholar 

  12. 12.

    U. Samuelsson, J. Anderzén, S. Gudbjörnsdottir, I. Steineck, K. Åkesson, L. Hanberger, Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood. J. Diabetes Complicat. 30, 917–922 (2016)

    Article  PubMed  Google Scholar 

  13. 13.

    R.R. Huxley, S.A. Peters, G.D. Mishra, M. Woodward, Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 3, 198–206 (2015)

    Article  PubMed  Google Scholar 

  14. 14.

    A. Zeoli, P. Dentelli, M.F. Brizzi, Endothelial progenitor cells and their potential clinical implication in cardiovascular disorders. J. Endocrinol. Invest. 32, 370–382 (2009)

    Article  PubMed  CAS  Google Scholar 

  15. 15.

    G.P. Fadini, S. De Kreutzenberg, M. Albiero, A. Coracina, E. Pagnin, I. Baesso, A. Cignarella, C. Bolego, M. Plebani, G.B. Nardelli, S. Sartore, C. Agostini, A. Avogaro, Gender differences in endothelial progenitor cells and cardiovascular risk profile: the role of female estrogens. Arterioscler. Thromb. Vasc. Biol. 28, 997–1004 (2008)

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    A. Rousseau, F. Ayoubi, C. Deveaux, B. Charbit, C. Delmau, S. Christin-Maitre, P. Jaillon, G. Uzan, T. Simon, Impact of age and gender interaction on circulating endothelial progenitor cells in healthy subjects. Fertil. Steril. 93, 843–846 (2010)

    Article  PubMed  Google Scholar 

  17. 17.

    Y. Zhen, S. Xiao, Z. Ren, H.W. Shen, H. Su, Y.B. Tang, H. Zeng, Increased endothelial progenitor cells and nitric oxide in young prehypertensive women. J. Clin. Hypertens. 17, 298–305 (2015)

    Article  CAS  Google Scholar 

  18. 18.

    R. Pop-Busui, A.J. Boulton, E.L. Feldman, V. Bril, R. Freeman, R.A. Malik, J.M. Sosenko, D. Ziegler, Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 40, 136–154 (2017)

    Article  PubMed  CAS  Google Scholar 

  19. 19.

    G. Corona, E.A. Jannini, M. Maggi, Inventories for male and female sexual dysfunctions. Int. J. Impot. Res. 18, 236–250 (2006)

    Article  PubMed  CAS  Google Scholar 

  20. 20.

    M.I. Maiorino, G. Bellastella, E. Della Volpe, O. Casciano, L. Scappaticcio, P. Cirillo, D. Giugliano, K. Esposito, Erectile dysfunction in young men with type 1 diabetes. Int. J. Impot. Res. 29, 17–22 (2017)

    Article  PubMed  CAS  Google Scholar 

  21. 21.

    M.I. Maiorino, G. Bellastella, F. Castaldo, M. Petrizzo, D. Giugliano, K. Esposito, Sexual function in young women with type 1 diabetes: the METRO study. J. Endocrinol. Invest. 40, 169–177 (2017)

    Article  PubMed  CAS  Google Scholar 

  22. 22.

    M.I. Maiorino, G. Bellastella, M. Petrizzo, E. Della Volpe, R. Orlando, D. Giugliano, K. Esposito, Circulating endothelial progenitor cells in type 1 diabetic patients with erectile dysfunction. Endocrine 49, 415–421 (2015)

    Article  PubMed  CAS  Google Scholar 

  23. 23.

    American Diabetes Association, Standard of medical care in diabetes 2017. 12. Children and adolescents. Diabetes Care 40, S105–S113 (2017)

    Article  Google Scholar 

  24. 24.

    A. Collier, S. Ghosh, M. Hair, N. Waugh, Gender differences and patterns of cardiovascular risk factors in Type 1 and Type 2 diabetes: a population-based analysis from a Scottish region. Diabet. Med. 32, 42–46 (2015)

    Article  PubMed  CAS  Google Scholar 

  25. 25.

    V. Manicardi, G. Russo, A. Napoli, E. Torlone, P. Li Volsi, C.B. Giorda, N. Musacchio, A. Nicolucci, C. Suraci, G. Lucisano, M.C. Rossi, and AMD Annals Study Group, Gender-disparities in adults with type 1 diabetes: more than a quality of care issue. A cross-sectional observational study from the AMD annals initiative. PLoS One 11, e0162960 (2016)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. 26.

    S. Carlsen, T. Skrivarhaug, G. Thue, J.G. Cooper, L. Gøransson, K. Løvaas, S. Sandberg, Glycemic control and complications in patients with type 1 diabetes—a registry-based longitudinal study of adolescents and young adults. Pediatr. Diabetes 18, 188–195 (2017)

    Article  PubMed  CAS  Google Scholar 

  27. 27.

    S.L. Hernandez, J.H. Gong, L. Chen, I.H. Wu, J.K. Sun, H.A. Keenan, G.L. King, Characterization of circulating and endothelial progenitor cells in patients with extreme-duration type 1 diabetes. Diabetes Care 37, 2193–2201 (2014)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. 28.

    N. Werner, S. Kosiol, T. Schiegl, P. Ahlers, K. Walenta, A. Link, M. Böhm, G. Nickenig, Circulating endothelial progenitor cells and cardiovascular outcomes. N. Engl. J. Med. 353, 999–1007 (2005)

    Article  PubMed  CAS  Google Scholar 

  29. 29.

    T. Hörtenhuber, B. Rami-Mehar, M. Satler, K. Nagl, C. Höbaus, F. Höllerl, R. Koppensteiner, G. Schernthaner, E. Schober, G.H. Schernthaner, Endothelial progenitor cells are related to glycemic control in children with type 1 diabetes over time. Diabetes Care 36, 1647–1653 (2013)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. 30.

    S. Sen, S.P. McDonald, P.T. Coates, C.S. Bonder, Endothelial progenitor cells: novel biomarker and promising cell therapy for cardiovascular disease. Clin. Sci. 120, 263–283 (2011)

    Article  PubMed  CAS  Google Scholar 

  31. 31.

    L. Sibal, A. Aldibbiat, S.C. Agarwal, G. Mitchell, C. Oates, S. Razvi, J.U. Weaver, J.A. Shaw, P.D. Home, Circulating endothelial progenitor cells, endothelial function, carotid intima-media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria. Diabetologia 52, 1464–1473 (2009)

    Article  PubMed  CAS  Google Scholar 

  32. 32.

    M. Rigato, A. Avogaro, G.P. Fadini, Levels of circulating progenitor cells, cardiovascular outcomes and death: a meta-analysis of prospective observational studies. Circ. Res. 118, 1930–1939 (2016)

    Article  PubMed  CAS  Google Scholar 

  33. 33.

    E. Ortona, M. Pierdominici, A. Maselli, C. Veroni, F. Aloisi, Y. Shoenfeld, Sex-based differences in autoimmune diseases. Ann. Ist. Super. Sanita 52, 205–212 (2016)

    PubMed  CAS  Google Scholar 

  34. 34.

    S.D. Solomon, E. Chew, E.J. Duh, L. Sobrin, J.K. Sun, B.L. VanderBeek, C.C. Wykoff, T.W. Gardner, Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care 40, 412–418 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    D.F. Penson, H. Wessells, P. Cleary, B.N. Rutledge, and Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Sexual dysfunction and symptom impact in men with long-standing type 1 diabetes in the DCCT/EDIC cohort. J. Sex. Med. 6, 1969–1678 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Maria Ida Maiorino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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These authors contributed equally: Maria Ida Maiorino and Giuseppe Bellastella.

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Maiorino, M.I., Bellastella, G., Casciano, O. et al. Gender-differences in glycemic control and diabetes related factors in young adults with type 1 diabetes: results from the METRO study. Endocrine 61, 240–247 (2018).

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  • Type 1 diabetes
  • Gender
  • Glycemic control
  • EPCs
  • Early adulthood
  • Cardiovascular risk