Exploring the gender gap: Why men are at higher risk of diabetes and its complications than women?

A new research has found that men with diabetes are at a higher risk of experiencing major health complications compared to diabetic women.

BySumit Jha

Published May 24, 2024 | 7:00 AMUpdatedMay 24, 2024 | 7:00 AM

Exploring the gender gap: Why men are at higher risk of diabetes and its complications than women?

The genetic makeup and lifestyle of men can complicate diabetes treatment and management. A new research study has found that men with diabetes are at a higher risk of experiencing major health complications compared to diabetic women.

Complications such as heart disease, and diseases affecting the legs, feet, kidneys, and eyes were observed more frequently in men than in women, regardless of the duration of their diabetes.

The study was conducted by researchers from The University of Sydney, Australia.

They found that 44 percent of the men experienced a cardiovascular complication, including stroke and heart failure, compared to 31 percent in women. The findings were published in the ‘Journal of Epidemiology and Community Health’.

Further, 25 percent and 35 percent of the men were found to develop conditions of leg and foot and kidney, respectively, as compared to 18 percent and 25 percent of the women, respectively.

Problems of the leg and foot included ulcers and bone inflammation, while those of the kidney included chronic disease and failure. Overall, the researchers found that diabetic men were 51 percent more likely to develop heart problems than diabetic women.

Men with diabetes were also found to be 55 percent and 47 per cent more likely to develop complications in the kidney and leg and foot, respectively.

However, regarding the overall risk of developing eye complications, the team found little difference between men and women.

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The research

The study included 25,713 people, all of them aged 45 years and above, and having either Type 1 or Type 2 diabetes.

Through surveys, the participants were followed up for 10 years for major health problems developed due to diabetes. The responses were then linked to their medical records.

Of the participants, 57 percent of the men developed these conditions, while 61 percent of the women developed them. Men were found to have a 14 percent higher risk of developing sight-threatening eye disease, diabetic retinopathy.

“Men had a 1.5-fold increased risk of cardiovascular disease (CVD), lower limb, and kidney complications, and a 14 percent greater risk of diabetic retinopathy compared to women, the authors said.

“These findings are reflected in the approximately 1.4 times higher 10-year rates for CVD, lower limb, and kidney complications in men compared with women,” they wrote.

The researchers said that while rates of developing complications due to diabetes rose in tandem with the number of years lived with the metabolic disease for both men and women, the sex-based differences in complication rates persisted.

As a possible explanation, the researchers pointed out that the men, who were part of the study were more likely to have well-known risk factors.

Men, in general, may also be less likely to make lifestyle changes, take preventive medications, or get health checks to lower their risks, they suggested.

Being an observational study, no causal factors could be established, the researchers said. They also acknowledged a lack of information on potentially influential factors, such as diabetes medications, glucose and blood pressure levels.

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Why men are at higher risk of developing diabetes?

The authors said that even though men with diabetes are at a higher risk of developing complications, these rates are high in both men and women.

The findings highlighted the need for targeted screening for complications, and prevention strategies following diagnosis, they said.

The higher risk of diabetes and its complications in men is multifactorial. It involves differences in fat distribution, hormonal influences, genetic factors, lifestyle behaviors, healthcare utilization, and disease management.

Men are at a higher risk of diabetes, potentially due to hormonal differences. In general, men tend to develop Type 2 diabetes at a lower BMI and younger age than women.

They are also more likely to experience complications from both Type 1 and Type 2 diabetes, such as heart disease, poor circulation in the legs, kidney failure, and vision impairment.

Scientists in Sweden have found that these sex differences might be due to varying hormone profiles between men and women, which affect fat metabolism. They suggest that diabetes treatments may need to be tailored based on sex.

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Gender disparities in diabetes risk, management

Research indicates that men are more likely to develop Type 2 diabetes at lower BMIs and younger ages than women, with unique gene expression profiles in their abdominal fat contributing to this increased risk.

This increased risk for men extends to diabetes and its complications, which can be attributed to a combination of biological, behavioural, and social factors.

“Men tend to accumulate visceral fat (fat around internal organs) more than women, who often store more subcutaneous fat (fat under the skin). Visceral fat is more metabolically active and contributes to insulin resistance, a precursor to Type 2 diabetes,” said Hyderabad-based Endocrinologist Dr Hari Reddy.

He added that testosterone in men can influence fat distribution and insulin sensitivity.

“Lower levels of testosterone are associated with an increased risk of insulin resistance and diabetes. In contrast, oestrogen in pre-menopausal women has a protective effect against diabetes by enhancing insulin sensitivity and protecting beta cells in the pancreas, ” Dr Reddy said.

“Also, certain genetic predispositions that increase diabetes risk may be more prevalent or expressed differently in men than in women,” he said.

According to Dr Reddy, men are more likely to engage in unhealthy behaviours such as poor diet, higher alcohol consumption, and smoking, which are risk factors for developing diabetes. They are also less likely to engage in regular health check-ups and preventive care, he said.

“Although men might engage in more intense physical activities, they also have higher rates of sedentary behaviour, particularly in middle age, which increases diabetes risk. Men are generally less likely to seek medical advice and preventive healthcare services compared to women. This can lead to later diagnosis and poorer management of diabetes,” said Dr Reddy.

He also pointed out that men might be less likely to seek help for mental health issues, leading to higher levels of unmanaged stress. This can in turn, contribute to insulin resistance and poor diabetes control.

“Men might also be less adherent to diabetes treatment and lifestyle modifications, resulting in poorer glycemic control and higher complication rates,” Dr Reddy added.

(Edited by Shauqueen Mizaj)