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Guest article by Sabine Dupont (Director, Strategy and Policy) and Maxence Prizzi  (Junior EU Policy & Advocacy Officer), International Diabetes Federation Europe​

Some 61 million people live with diabetes in Europe, of whom about 90% have type 2 diabetes (T2D) [1], in which the body may not produce enough insulin and/or not be able to use the insulin it produces effectively. T2D results from a combination of unmodifiable, genetic, physiological, environmental, and modifiable, behavioural risk factors. A further 5-10% live with type 1 diabetes, an autoimmune disease, in which the body destroys insulin-producing cells (β-cells) in the pancreas. A third common form of diabetes is gestational diabetes (GDM), which develops during pregnancy and disappears after birth, and affects one in seven pregnancies in Europe.

While the ratio of men to women is relatively even (prevalence is slightly higher among men, who also account for slightly more than half the cases), there are significant disparities in health outcomes and in the risk of developing diabetes-related complications linked to gender. For example:

• Women with T1D are at a 40% higher risk of premature death than their male counterparts [2].
• Women with T2D have a 27% increased risk of stroke and a 44% increased excess risk of coronary heart disease than men [2].
• Women living with diabetes are disproportionately affected by depression and anxiety, which can negatively affect their ability to optimally manage the condition [2].

These differences are partly driven by biological differences and partly by socio-economic health determinants that hinder women’s access to healthcare and health-enabling environments and inform different health-seeking behaviours.

Socio-economic factors, for example, are believed to account for a delay in women’s diabetes diagnosis of approximately 4.5 years compared to men [3]. Data from some high-income countries has also shown that women were less likely to receive care as per recommended guidelines and were also less likely to adhere to strict glycemia-lowering therapy [4]. Cross-sectional studies have shown similar results in terms of gender differences in several European countries such as the UK, Germany, and Italy [5].

Women’s biological specificities also pose significant challenges. Fluctuations associated with menstrual cycles and menopause complicate blood glucose management, increasing the risk of diabetes-related complications [6].

Pregnancy is a major source of risk for the mother and the unborn child, both for women with pre-existing diabetes before their pregnancy and for women who develop GDM.

• A study on more than 47,900 deliveries over a decade has demonstrated that GDM increases the risk for cardiovascular mortality in women [7].
• After pregnancy, up to 50% of women who had GDM will develop type 2 diabetes within five years [8].
• Their children are six times more likely to develop type 2 diabetes and childhood obesity compared to children born to women without GDM [7].

The mental and psychological impact of living with diabetes has also been proven to affect women more, with women twice as likely as men to suffer from depression and anxiety related to living with diabetes [9].

All of which shows that reducing the gender health gap and addressing the systemic barriers faced by women in our healthcare systems must be a key priority. IDF Europe urges policymakers to:

Invest in research:

• Promoting research into sex and gender differences to better understand biological and psychosocial impacts and address unmet medical needs.
• Improving women’s representation in clinical trials and research on diabetes.

Improve access to high-quality care:

• Improving early diagnosis and treatment of women living with diabetes (including access to person-centred, personalized, and integrated care).
• Enhancing screening and care for women with GDM, including follow-up programmes for both mother and child to prevent or detect T2D early.
• Aligning clinical guidelines with the latest sex- and gender-sensitive evidence on diabetes prevention and management.

Develop an adequate policy framework:

• Investing in research and initiatives that address the specific needs of women living with diabetes.
• Adopting a health-in-all-policies approach to eliminate biases and remove socio-economic barriers preventing women with diabetes from achieving optimal health outcomes.

Sources:

[1] Lancet Diabetes Endocrinology. (2017). Sex disparities in diabetes: bridging the gap. Lancet Diabetes Endocrinol, 5(11), 839.
[2] Sex Disparities in Diabetes – https://www.thelancet.com/action/showPdf?pii=S2213-8587%2817%2930336-4.
[3] Westergaard, D., Moseley, P. L., Sørup, F. K. H., Baldi, P., & Brunak, S. (2019). Population-wide analysis of differences in disease progression patterns in men and women. Nature Communications, 10(1). https://doi.org/10.1038/s41467-019-08475-9.
[4] Lancet Diabetes Endocrinology. (2017). Sex disparities in diabetes: bridging the gap. Lancet Diabetes Endocrinol, 5(11), 839.
[5] Suresh, N., & Thankappan, K. R. (2019). Gender differences and barriers women face in relation to accessing type 2 diabetes care: A systematic review. Indian Journal of Public Health, 63(1), 65.
[6] Kapur A, Seshiah V. Women & diabetes: Our right to a healthy future. Indian J Med Res. 2017 Nov;146(5):553-556. doi: 10.4103/ijmr.IJMR_1695_17. PMID: 29512595; PMCID: PMC5861464.
[7] Kessous, R., Shoham-Vardi, I., Pariente, G., Sherf, M., & Sheiner, E. (2013). An association between gestational diabetes mellitus and long-term maternal cardiovascular morbidity. Heart, 99(15), 1118-1121.
[8] Women and Diabetes in the EU; European Institute of Women’s Health (EIWH); Policy Brief Eurohealth, reviewed by Sophie Peresson: Regional Director IDF-Europe; 2017. https://eurohealth.ie/eu-women-and-diabetes-2022/.
[9] The American Diabetes Association: Where Diabetes Meets Depression, https://diabetes.org/health-wellness/diabetes-your-health/mental/are-you-experiencing-depression.