Can diabetes screening improve the long-term health of women’s hearts?

Padma Kaul, co-director of the Canadian VIGOUR centre and member of the Women and Children’s Health Research Institute (WCHRI), is the CIHR Sex and Gender Science Chair in Diabetes.

Padma Kaul, co-director of the Canadian VIGOUR centre and member of the Women and Children’s Health Research Institute (WCHRI), is taking her research in a new direction as the newly aappointed CIHR Sex and Gender Science Chair in Diabetes. Kaul is one of 15 researchers across the country who have received 175 K per year, for four years, to investigate the biological and social influences specific to sex and gender that can have significant impact across all of the medical specialties. 

The University of Alberta professor of cardiology is applying her background in population-based research, women’s health, social determinants of health and cardiovascular disease to learn how diabetes screening can be improved for better long-term cardiovascular health in women. Kaul explores the topic in the following Q&A. 

What is the focus of your project?

The title of the research is the “Rediscover Project,” and the goal is to look at real-world evidence on the effects of the association between sex and diabetes on heart disease. People often think of heart disease as a man's disease, but we know now that it's increasingly the number 1 killer of women. Some research suggests that women have a natural advantage due to their reproductive hormones, which have shown to help protect from heart disease until they reach menopause, meaning that they tend to have lower rates of heart disease than men. However, if women develop diabetes, it is thought to negate the female advantage and the risk for heart disease goes up.

Given that Alberta has unique data on populations, the study will first look at population data to determine whether screening for diabetes is done similarly between men and women, or if there are noticeable sex- and gender-based differences. 

A second part of the project will investigate the screening methodology. When diabetes patients are screened, they test for certain levels of hemoglobin in the blood. There is a standardized threshold used, so anyone who has hemoglobin numbers above a certain threshold gets diagnosed with diabetes. What I'm going to explore is whether lower levels than the diabetes threshold are also associated with increased heart disease, or if they give us any information about the risk of development. 

The third part of this program will investigate whether drugs for diabetes are prescribed in a similar fashion for men and women, and whether they have similar outcomes.

You mentioned unique data sets in Alberta. Can you explain this a bit more?

Alberta has unique population data compared to the rest of Canada because we have the centralized Alberta Health Services, which allows researchers and clinicians to link population data such as lab tests, drugs and hospitalizations. That's unique, and similar perhaps to Scandinavian countries who have similar databases on their population. Using that unique data, we can look at different markers in the screening process to identify any patterns that might emerge. For example, we can look at who was screened, what the followup process is, what are their results, what drugs they get and so on. This way we can really longitudinally track patient outcomes. 

I plan to develop an inception cohort of people with similar characteristics, in addition to the general population, so we can track the disease over time. We will compare patients over 50 who have either heart disease or diabetes with other Albertans in the same age group. After tracking them for 10 years, we will see how many of them are screened, how many developed the disease and how many developed adverse outcomes down the road. It's a unique study that can only be implemented in very few jurisdictions around the world.

Is the sex and gender component of your research a new direction?

This program actually builds on the entire program of research I've done for the last 20 years, because I've looked at diabetes during pregnancy, then followed women who have diabetes diagnosed during pregnancy and tracked if they develop heart disease down the road. And I've looked at the other side, which is looking at heart disease and sex differences, and how women and men receive treatment. This project brings both of those similar yet different programs of research together into one component, so it's quite exciting.

Do you have any hunches about what the outcomes might be?

As I was saying, I’ve done research looking at women who had diabetes during pregnancy, and we've seen some women who have diabetes in pregnancy who are really high risk for developing actual Type 2 diabetes. The guidelines recommend that they be screened for diabetes within six to 18 months. We've done that research and found that less than 50 per cent actually get a screening.

So I wondered, if we found less than 50 per cent screening in women who have just delivered, does this screening rate extend to the general population, and is there a difference between men and women? I'm hoping that there isn’t, but I don't know because there is no data. 

Why do you think sex and gender research is important?

I think the reason why CIHR even has the sex and gender chair is the scientific community is recognizing that sex plays a huge role in how we diagnose and treat patients and what the outcomes are. My study, which uses existing databases, doesn't get into the gender aspect of it, but of course that matters as well. 

I think we're increasingly recognizing that we have to use that lens to look at everything when you talk about health care. I'm hoping that for the U of A and for Alberta, this can increase awareness and interest in this kind of research, to the extent that we could do this type of work for a whole population. That would be a significant advantage.