Gender Medicine | Diabetes | Differences between men and women

Gender Medicine

Diabetes: Differences between men and women

More and more people contract diabetes. The worldwide distribution of the condition shows significant regional differences. On the one hand, these reflect the differing genetic predispositions of the various ethnic groups, and on the other, the influence of differing cultures and behaviors.

Throughout Europe, the disease has increased by 40 % in the last 20 years; in Austria, the figure is 9 %. About 90 % of the patients are affected by type 2 diabetes. This is often caused by obesity. In addition to type 1 diabetes (and less common forms), gestational diabetes (pregnancy diabetes) is another form of diabetes that is increasing rapidly, already affecting 10 % of all pregnant women. Although the manifestations of gestational diabetes can vary widely, its effects on the body are very similar to those of type 2 diabetes. Hence, gestational diabetes is often considered a precursor to type 2 diabetes.

Sex-specific distribution of type 1 and 2 diabetes

Both type 1 and type 2 diabetes affect slightly more men than women, although the incidence in both sexes is relatively similar over the lifetime. A recent US study showed a relative annual increase in new cases by 1.8 % in type 1 diabetes and 4.8 % in type 2 diabetes in adolescents, with boys more frequently affected by type 1 diabetes and girls more frequently by type 2 diabetes.

Autoimmune disease – type 1 diabetes

In the autoimmune disease type 1 diabetes, there is a still unexplained link between the age at which the condition first manifests, sex, and the incidence of microvascular complications (small blood vessels). For example, male adolescents are more likely to later develop kidney disease (nephropathy) or retinal damage (retinopathy) if the disease sets in after puberty than girls of the same age are. In girls, by contrast, transient insulin resistance is more pronounced during puberty than it is in male adolescents. Moreover, eating disorders are more common in girls with type 1 diabetes. The risk of insulin purging (deliberate omission of insulin doses in order to lose weight via a metabolic derangement) for weight control is also increased. In girls, type 1 diabetes is often not detected before the stage of ketoacidosis – a life-threatening condition triggered by severe insulin deficiency.

Type 2 diabetes – a widespread disease

The large increase in the incidence of type 2 diabetes is due not to genetic causes, but rather to our increasingly unhealthy lifestyle with lack of physical exercise, overeating and qualitative malnutrition (“junk food”).

Men usually contract type 2 diabetes earlier, with lower overweight, than women do. This is partly due to the different genetic predisposition and the sex-specific hormones. In addition, in men there is on average greater insulin resistance, typically male (androgenic) fat distribution with more abdominal and hepatic fat, and an earlier risk of developing metabolic syndrome, which favors the development of type 2 diabetes. By contrast, obese women are less likely to exhibit classic cardiometabolic risk factors.

In addition to the classic risk factors described, other influences also play a role. The international guidelines on type 2 diabetes therefore stipulate to take factors such as age, social environment, duration of illness, or concomitant health-related complaints into account. However, differences between the sexes – both biological and psychosocial ones – have not been considered so far. Yet, due to the sex-specific disease risks, co-morbidities (concomitant disease) and complication rates, the treatment of type 2 diabetes should be sex-specific and personalized.

Metabolic effects of sex hormones

Sex hormones play an important role in the regulation of metabolism. For example, pre-menopausal women are better protected from developing metabolic syndrome and type 2 diabetes than men of the same age are, by virtue of their blood glucose-lowering (antidiabetic) female sex hormones, in particular the hormone estrogen.

Sex-specific risk factors for diabetes

Other sex-specific factors that promote the development of type 2 diabetes include psychosocial stress, stress at work, or lack of sleep, which are more common in women than they are in men. Men in turn are more vulnerable to diabetes at a later age if their mothers were malnourished during pregnancy. In addition, hormone-active substances (such as bisphenol A or phthalates in plastic articles) seem capable of influencing the diabetes risk differently, depending on age and gender.

Healthy diet and physical exercise

With regard to diabetes, men and women alike benefit from structured training programs and lifestyle changes. In this regard, men should pay more attention to a healthy diet, while women should focus more on exercise (preferably a combination of endurance and strength training).

Sex-specific treatment for diabetes

Nowadays, there are a number of anti-diabetic drugs that address a wide variety of origins and developmental patterns of diabetes. The ever-growing range of designer insulins allows personalized therapy that takes into account the biography, social environment, and concomitant diseases of the patients. Today, for example it is known that, especially with efficient and easy basal insulin-supported oral therapies (BOTs), the rates of hypoglycemia (too low blood glucose levels) are higher in women, especially if they are less prone to obesity. In addition, insulin management is more difficult for younger women with diabetes, because it is cycle-dependent.

Diabetes & pregnancy

In younger women with diabetes, planning of a pregnancy is still considered a challenge, both for the patients themselves and for the attending physicians. Moreover, in the prescription of medicines (e.g. statins or RAS blockers) to women of childbearing age possible biological, chemical, or physical factors (teratogenic effects) that may lead to malformations in the child must be taken into account. Thus, in case of pregnancy the drug metformin may be prescribed for the treatment of diabetes. For women with PCOS or after gestational diabetes, this drug is also suitable.

Cardiovascular disease in diabetes

In diabetes, the main cause of death is vascular complications, in males and females alike. Women with diabetes are 30–40 % more likely to have a myocardial infarction or a stroke than men are. Women also lose more somewhat more lifetime from diabetes than men do. However, thanks to better care and multifactorial therapy (e.g. by including statins and RAS inhibitors into the therapy), complications such as blindness, kidney failure, myocardial infarction, stroke, and death in both type 1 and type 2 diabetes have decreased strongly, in men somewhat more than in women. Gender-aware personalized therapy could further improve the quality of life of men and women with diabetes in the future.

The author, Prof. Dr. med. Alexandra Kautzky-Willer, Medical University of Vienna (MedUni Vienna), is the scientific director of the Institute for Gender Medicine in Gars am Kamp, a healthcare facility of VAMED in cooperation with MedUni Vienna.

These article might also can interest you:

+ "Part 1 - What is Gender Medicine? - The Genders" - from Univ. Prof. Dr. Alexandra Kautzky-Willer
+ "Part 2 - What is Gender Medicine? - physical differences, metabolism, energy balance, sex hormones, life expactancy & Smoking" - from Univ. Prof. Dr. Alexandra Kautzky-Willer
+ "Part 3 - What is Gender Medicine? - Cardiology, body weight, cancer, depression & medications" - from Univ. Prof. Dr. Alexandra Kautzky-Willer



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Univ. Prof. Dr. Alexandra Kautzky-Willer Institute for Gender Medicine

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