Diagnose Diabetes: Why Women Are Disadvantaged

Women are also disadvantaged in the context of the global diabetes wave. They are diagnosed with the disease later and already with more complications than men. Female diabetics are often treated less intensively. This was noted by Vienna experts Michael Leutner and Alexandra Kautzky-Willer (MedUni Vienna/AKH) in a perspective paper in the "Deutsches Ärzteblatt".

Initial Diagnosis Often Occurs Later in Women

The issue of gender differences apparently begins early in the disease history. Women are often more severely ill than men at the initial diagnosis of diabetes. Men are usually diagnosed with type 2 diabetes (T2DM; note) at a younger age. However, at the time of diagnosis, more women have obesity and also more frequently have arterial hypertension (high blood pressure; note) as well as greater weight gain. "Women with T2DM more often suffer from diabetes distress and psychosocial stress," wrote the Vienna experts with regard to the existing scientific literature.

Differences Between Genders From the Start

Even in the development of non-insulin-dependent diabetes, there are clear characteristics that may be decisive for women and men respectively. "In both genders, an increased body mass index (BMI; note) and especially waist circumference are associated with the development of diabetes diseases. In women, increased testosterone concentrations and decreased estrogen concentrations are associated with an increased risk for T2DM. In contrast, decreased testosterone concentrations in men increase the risk of diabetes. Non-alcoholic fatty liver disease and visceral fat tissue (abdominal fat; note) seem to particularly promote the risk of developing diabetes in women. One of the most important risk factors for the development of T2DM in women is a previous gestational diabetes (temporary diabetes during pregnancy; note)," according to the topic summary in the publication of the German Medical Association.

For women, negatively acting factors of various kinds may lead to a particularly poor risk constellation: "Menopause also plays an important role because during this phase the cardiometabolic risk (cardiovascular/metabolic risk; note) increases dramatically. Women with type 2 diabetes mellitus (T2DM) have a higher relative risk for cardiovascular diseases and a higher mortality rate. The prescribed target values are less often achieved in women with diabetes mellitus, which is also due to a lack of diagnosis and therapy."

Female Patients Disadvantaged in Care

In the management of diabetes, it is crucial to avoid late complications. These are based on atherosclerosis of the small and large blood vessels, which progresses faster and earlier with poor blood sugar and other metabolic control.

"Microvascular diseases: In people with T2DM, a higher risk of kidney disease has been found in women, which may be due to poorer risk factor management. Women with T2DM more frequently experience neuropathic pain and nerve injuries (often poorly treatable nerve pain/polyneuropathy; note) compared to men," the experts wrote. However, no gender-specific differences could be found in diabetic retinopathies (damage to the retina; note).

The same applies to diseases due to damage to the large blood vessels. Leutner and Alexandra Kautzky-Willer: "Macrovascular diseases: Cardiovascular diseases (heart attack, stroke, etc.; note) are the number one cause of death worldwide. People with T2DM have an increased risk of dying prematurely from cardiovascular diseases. Although the absolute risk of cardiovascular mortality is higher in men with T2DM, women have a higher relative risk. In women, more advanced atherosclerosis was described, especially at the time of T2DM diagnosis."

Personalized Medicine Not Yet Gender-Specific in Type 2 Diabetes

On the other hand, women seem to fare worse when it comes to considering their cardiovascular risk factors. "The prescription of medications such as aspirin (thrombosis prevention; note), beta-blockers (high blood pressure; note), or statins (cholesterol reduction; note) is also less frequent. As a result, women have higher blood pressure values, glucose levels, and LDL cholesterol concentrations. Women with T2DM have a higher relative risk of heart failure and hospitalizations due to heart failure compared to men. Women with T2DM more frequently suffer from depression and anxiety disorders (...). In summary, women are less frequently treated according to guidelines," the experts note.

The conclusion of the Vienna metabolic experts, who also focus particularly on gender medicine: "There are significant gender-specific differences in T2DM in diagnostics, development, treatment, and the progression of secondary diseases. To move closer to the goal of personalized medicine, these gender-specific differences must be considered and implemented in clinical practice."

Worldwide, by 2021, almost 540 million people were already affected by type 2 diabetes, which accounts for about 90 percent of diabetes cases. The development of initially non-insulin-dependent diabetes is mainly promoted by increasing overweight and obesity.

(APA/Red)

This article has been automatically translated, read the original article here.