Diabetes can affect anyone, but it doesn’t affect everyone in the same way. Sex – whether you are born male or female – is a major factor influencing your diabetes journey.

Women are, overall, more likely to experience complications from diabetes than men. They also tend to have a higher risk factor burden when diagnosed, including excess weight and hypertension – especially at a younger age. Women with diabetes are also more likely to have higher blood pressure and cholesterol levels than men.  

It isn’t all bad news, thought. Studies have identified that women’s risk of developing type 1 diabetes drops dramatically as they go through puberty. The suggestion is that oestrogen offers some protection against type 1 (teenage girls with lower amounts of oestrogen in their bloodstream do not have a reduced risk). It’s also been identified that women with high blood testosterone levels are at increased risk of developing type 2 diabetes. 

Overall, being born male puts you at increased risk of a number of health conditions, including type 2 diabetes. Men are usually diagnosed at a younger age and with lower body fat mass than women. Worldwide, around 18 million more men have diabetes than women.  Men are also more likely to be diagnosed with type 1 diabetes. This means type 1 diabetes is the only autoimmune condition where women tend to be affected less.

Being female does increase the risk of certain complications from diabetes. Research suggests that blood glucose control is worse in adult women than men.

The nature of prediabetes also differs between the sexes, with women more often showing high post-meal blood glucose levels. This difference is caused by different biological mechanisms, with women’s post-prandial (after meal) hyperglycaemia mainly due to peripheral insulin resistance (when skeletal muscles no longer absorb glucose effectively). 

This is important because post-prandial hyperglycaemia is a predictor of progression to diabetes. It also carries an increase in cardiovascular risk. This underlines the importance of performing oral glucose tolerance tests for screening in women, if prediabetes is suspected. 

Complications

Being female also increases the risk of certain complications from diabetes. Research suggests that blood glucose control – in both type 1 and type 2 diabetes – is worse in adult women than men. The reasons for this may not be entirely biological. One possible explanation is the caring load, as women often have to manage their family’s health as well as their own. 

Men without diabetes tend to be at much higher risk of kidney disease than women without diabetes. However, this trend is reversed in people with diabetes – women with diabetes are at higher risk of kidney disease, and this risk increases with age.  

Women and pregnancy

A history of gestational diabetes seems to be the clearest risk factor for the development of type 2 diabetes. The risk of complications from diabetes also increases for women with menopause, while those with polycystic ovary syndrome (PCOS) or early menopause are also more at risk of developing type 2. Other possible complications include difficulty getting pregnant, higher risk preeclampsia and lower libido. 

Everyone’s diabetes journey is unique. There are many other factors than your sex which will influence how the condition is experienced. But it is worth discussing with your health professionals how being female might affect your diabetes management and whether there are particular risks or complications for which you should be watchful.