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Marianne J Legato

Publications and source records attributed to Marianne J Legato.

At least 19 recordsLinked to original sources
PubMed2006

Gender-specific care of the patient with diabetes: review and recommendations.

BACKGROUND: Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have focused almost exclusively on men. OBJECTIVE: The purpose of this review was to survey the literature about the sex-specific features of DM and to make recommendations for the gender-specific care of patients. METHODS: An initial literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender, women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search terms were included. The strength of each recommendation was assessed. RESULTS: : Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for CAD. Disease management programs for patients with diabetes have been shown to save money and improve outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes available. CONCLUSION: Gender-specific care of the patient with diabetes should be informed by evidence-based recommendations.

Cardiovascular Diseases↗
PubMed2005

"Never again?".

Explore the source record for details and available documents.

Humans↗
PubMed2003

Beyond women's health the new discipline of gender-specific medicine.

At its best, women's health is not something to be developed as an isolated discipline. If instead biologic sex is used as an important variable in research protocols, studying and comparing men and women directly, the data prompt the formulation of questions that never otherwise would be asked. In answering those questions, one can fashion more accurate and complete models not only of human physiology, but also of the pathophysiology of disease.

Female↗
PubMedDate not supplied

The changing position of women in the medical marketplace: women's health morphs into gender-specific medicine.

Traditionally, society--including the academic medical community--has concentrated on the male patient. Women were protected from clinical investigation on human subjects. However, World War II brought about far-reaching changes. The experience of Americans during the prolonged struggle gave them an enduring confidence in the power of science to prolong and improve human life that culminated in the expansion of the National Institutes of Health under the leadership of James A. Shannon. The other profound change in American society was in the attitude of women, who, as a result of their enormously increased options during the war to hold jobs and enter professions that had previously been the exclusive province of men, united in the feminist movement. By the end of the 1980s, the voices of women themselves galvanized the United States government to effect a series of maneuvers that have revolutionized our concept of the importance of biological sex in human biology. This paper reviews the changes in American medical research, and the delivery of medical care, to men and women over the past century, which laid the foundation for an in-depth exploration of the impact of gender on normal human function and the way human beings experience disease.

Delivery of Health Care↗