Sex Differences in the Burden and Complications of Diabetes

Sanne A E Peters, Mark Woodward, Sanne A E Peters, Mark Woodward

Abstract

Purpose of the review: To review the latest evidence on sex differences in the burden and complications of diabetes and discuss the potential explanations for the sex differences described.

Recent findings: Diabetes is a strong risk factor for vascular disease, with compelling evidence that the relative risks of vascular diseases conferred by diabetes are considerably greater in women than men. The mechanisms underpinning women's excess relative risk of vascular disease from diabetes are unknown. Sex differences in the health care provided for the prevention, management, and treatment of diabetes and its complications could contribute to women's greater excess relative risks of diabetes complications. However, since the excess risk of vascular disease is not seen for other major vascular risk factors, inherent biological factors may be more likely to be involved. In addition to other cardiometabolic pathways, the sex dimorphism in body composition and fat distribution may be particularly important in explaining women's greater excess risk of the vascular complications of diabetes. There is strong evidence to suggest that diabetes is a stronger risk factor for vascular disease in women than men. Although several mechanisms may be involved, further research is needed to provide new and deeper insights into the mechanisms underpinning sex differences in the association between diabetes and vascular diseases. Such research will inform patients, health care professionals, and policy makers to ensure that women are not disproportionately affected by diabetes, and will help to reduce the burden in both sexes.

Keywords: Cardiovascular disease; Diabetes; Men; Sex differences; Women.

Conflict of interest statement

Conflict of Interest

Sanne A.E. Peters declares no conflict of interest.

Mark Woodward reports personal fees from Amgen.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Comparison of age-standardised prevalence of diabetes in men and women in 1980 and 2014. (Reproduced from: Lancet 2016; 387(10027): 1513–30; 10.1016/S0140-6736(16)00618-8; Creative Commons user licence https://creativecommons.org/licenses/by/4.0/) [••]
Fig. 2
Fig. 2
Results from prior meta-analyses of sex differences in the effects of diabetes on vascular outcomes, summarised through the ratios of women-to-men adjusted relative risks (and 95% confidence intervals) pooled across cohort studies
Fig. 3
Fig. 3
Results from prior meta-analyses of sex differences in the effects of diabetes on cancer, summarised through the ratios of women-to-men adjusted relative risks (RR) (and 95% confidence intervals) pooled across observational studies. The results for colorectal, liver, lung, and any cancer are from cohort studies only; the rest also include case-control studies

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