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Cited by 624Sex and Gender in HealthcareDiabetes, Cardiovascular Risks, and LipoproteinsGestational Diabetes Research and Management

The DOI matches its Crossref record; 137 of the 138 references it cites were found in a registry or an index.

Sex differences in type 2 diabetes

Open access
Kautzky-Willer, Alexandra, Leutner, Michael, Harreiter, Jürgen·2023·Diabetologia
DOI 10.1007/s00125-023-05891-xPMC PMC10163139
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Abstract

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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Fig. 1 Sex-specific risks and sex and gender differences in risk factors and clinical features of men and women with type 2 diabetes. Significant differences in type 2 diabetes risk predictors between men and women are indicated (§). Physiological characteristics related to type 2 diabetes risk in men and/or women are shown in the centre of the figure in boxes. In general, men have greater insulin resistance and higher fasting glucose levels and higher visceral fat mass than women. However, VAT (or waist circumference as a marker of central obesity) appears to be a better predictor of insulin resistance and development of type 2 diabetes and CVD in women than in men. In women, CVD risk factors like obesity and hypertension progress during menopausal transition, further aggravating insulin resistance, inflammation and dyslipidaemia. At type 2 diabetes diagnosis, women often show larger excess weight gain and higher levels of obesity, as well as higher BP, than men, presenting with an overall higher cardiometabolic disease risk factor burden. Figure created in BioRender.com. This figure is available as part of a downloadable slideset
Fig. 1 Sex-specific risks and sex and gender differences in risk factors and clinical features of men and women with type 2 diabetes. Significant differences in type 2 diabetes risk predictors between men and women are indicated (§). Physiological characteristics related to type 2 diabetes risk in men and/or women are shown in the centre of the figure in boxes. In general, men have greater insulin resistance and higher fasting glucose levels and higher visceral fat mass than women. However, VAT (or waist circumference as a marker of central obesity) appears to be a better predictor of insulin resistance and development of type 2 diabetes and CVD in women than in men. In women, CVD risk factors like obesity and hypertension progress during menopausal transition, further aggravating insulin resistance, inflammation and dyslipidaemia. At type 2 diabetes diagnosis, women often show larger excess weight gain and higher levels of obesity, as well as higher BP, than men, presenting with an overall higher cardiometabolic disease risk factor burden. Figure created in BioRender.com. This figure is available as part of a downloadable slidesetCC BY · PubMed Central
Fig. 2 Illustration of the most important sex differences in the complications and possible effects of pharmacological therapy and management of patients with type 2 diabetes. CV, cardiovascular; GI, gastrointestinal; HF, heart failure; UTI, urinary tract infection. Figure created in BioRender.com. This figure is available as part of a downloadable slideset
Fig. 2 Illustration of the most important sex differences in the complications and possible effects of pharmacological therapy and management of patients with type 2 diabetes. CV, cardiovascular; GI, gastrointestinal; HF, heart failure; UTI, urinary tract infection. Figure created in BioRender.com. This figure is available as part of a downloadable slidesetCC BY · PubMed Central

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Research works printed but not linked: 1

  1. International Diabetes Federation (2021) IDF Diabetes Atlas, 10th edn. International Diabetes Federation, Brussels

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Metadata

Authors
Kautzky-Willer, A., Leutner, M., & Harreiter, J.
Affiliations
Medical University of Vienna (AT)
ORCID
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2023-03-10
Volume
66
Issue
6
Pages
986-1002
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-023-05891-x
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
Licence
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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