Sex differences in type 2 diabetes
Open accessAbstract
The prevalence of type 2 diabetes mellitus is increasing in both sexes, but men are usually diagnosed at a younger age and lower body fat mass than women. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus. Women appear to bear a greater risk factor burden at the time of their type 2 diabetes diagnosis, especially obesity. Moreover, psychosocial stress might play a more prominent role in diabetes risk in women. Across their lifespan, women experience greater hormone fluctuations and body changes due to reproductive factors than men. Pregnancies can unmask pre-existing metabolic abnormalities, resulting in the diagnosis of gestational diabetes, which appears to be the most prominent risk factor for progression to type 2 diabetes in women. Additionally, menopause increases women’s cardiometabolic risk profile. Due to the progressive rise in obesity, there is a global increase in women with pregestational type 2 diabetes, often with inadequate preconceptual care. There are differences between men and women regarding type 2 diabetes and other cardiovascular risk factors with respect to comorbidities, the manifestation of complications and the initiation of and adherence to therapy. Women with type 2 diabetes show greater relative risk of CVD and mortality than men. Moreover, young women with type 2 diabetes are currently less likely than men to receive the treatment and CVD risk reduction recommended by guidelines. Current medical recommendations do not provide information on sex-specific or gender-sensitive prevention strategies and management. Thus, more research on sex differences, including the underlying mechanisms, is necessary to increase the evidence in the future. Nonetheless, intensified efforts to screen for glucose metabolism disorders and other cardiovascular risk factors, as well as the early establishment of prophylactic measures and aggressive risk management strategies, are still required for both men and women at increased risk of type 2 diabetes. In this narrative review we aim to summarise sex-specific clinical features and differences between women and men with type 2 diabetes into risk factors, screening, diagnosis, complications and treatment. Graphical abstract
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Women treated with GLP-1 RAs may experience greater glycaemic control and weight-reduction benefits, as well as a higher incidence of gastrointestinal adverse events, compared with men.
“women treated with GLP-1 RAs may experience greater glycaemic control and weight-reduction benefits, as well as a higher incidence of gastrointestinal adverse events, compared with men [59]”
From Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [59]
The pharmacological therapy and management section reports greater weight reduction and a higher risk of gastrointestinal side effects in women taking GLP-1RAs. It says most trials found similar HbA1c reductions in both sexes; only exenatide combined with metformin appeared especially effective in women. The claim therefore overgeneralises the glycaemic-control benefit. (LLM, conf=0.90)
Experimental — accuracy not yet measuredEvidence suggests that sex differences may influence the efficacy and safety profiles of GLP-1 RAs.
“evidence suggests that sex differences may influence the efficacy and safety profiles of GLP-1 RAs [59]”
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- Authors
- Kautzky-Willer, A., Leutner, M., & Harreiter, J.
- Affiliations
- Medical University of Vienna (AT)
- Venue
- Diabetologia
- Published
- 2023-03-10
- Volume
- 66
- Issue
- 6
- Pages
- 986-1002
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC10163139
- OpenAlex
- W4323804403
- Cited by
- 624
- References
- 138
- Citations by year
- 2026: 181 · 2025: 237 · 2024: 172 · 2023: 34
- FWCI
- 30.72
- Type
- journal article
- Language
- en
- Update notices
- correction (2023-04-12)
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- GENDER-NET Plus ERA-NET Initiative (GOING-FWD funded by the GENDER-NET Plus ERA-NET In)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Keywords
- type 2 diabetes, sex differences, women, gestational diabetes mellitus, menopause, obesity, psychosocial stress, cardiovascular risk, diabetes complications, diabetes screening, diabetes diagnosis, medication adherence, reproductive factors
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Male, Obesity, Risk Factors, Sex Characteristics, Sex Factors, Prevalence
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