Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course

Abstract

By 2017 estimates, diabetes mellitus affects 425 million people globally; approximately 90-95% of these have type 2 diabetes. This narrative review highlights two domains of sex differences related to the burden of type 2 diabetes across the life span: sex differences in the prevalence and incidence of type 2 diabetes, and sex differences in the cardiovascular burden conferred by type 2 diabetes. In the presence of type 2 diabetes, the difference in the absolute rates of cardiovascular disease (CVD) between men and women lessens, albeit remaining higher in men. Large-scale observational studies suggest that type 2 diabetes confers 25-50% greater excess risk of incident CVD in women compared with men. Physiological and behavioural mechanisms that may underpin both the observed sex differences in the prevalence of type 2 diabetes and the associated cardiovascular burden are discussed in this review. Gender differences in social behavioural norms and disparities in provider-level treatment patterns are also highlighted, but not described in detail. We conclude by discussing research gaps in this area that are worthy of further investigation.

Keywords: Cardiovascular disease; Diabetes mellitus, type 2; Life course development; Lifestyle; Obesity; Review; Sex differences; Type 2 diabetes.

Figures

Fig. 1

Sex differences in insulin resistance across the life span. Adapted from [9] with permission from Elsevier. This figure is available as part of a downloadable slideset

Fig. 2

Obesity levels are higher among women than men at the time of type 2 diabetes diagnosis. (a, b) Sex differences in the prevalence of diabetes/impaired glucose tolerance (IGT) (a) and being overweight (BMI ≥25) or obese (BMI ≥30) (b) by age (adapted from [22]). (c) BMI at diabetes diagnosis by age (adapted from [41] by permission from Springer Nature). This figure is available as part of a downloadable slideset