Gender-Based Differences in Glycemic Control in T2DM

Women have smaller improvement in HbA1c and more hypoglycemia and nocturnal hypoglycemia…

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For patients with type 2 diabetes, there are gender-based differences in glycemic control and hypoglycemia after insulin treatment, according to published research. The purpose of the study was to to determine the impact of gender on glycemic control and hypoglycemia in insulin-naïve patients with type 2 diabetes (T2DM).

Alexandra Kautzky-Willer, M.D., from the Medical University of Vienna, and colleagues pooled data from six randomized trials of insulin glargine or NPH insulin in insulin-nave, inadequately controlled patients with type 2 diabetes. A total of 1,251 female patients and 1,349 male patients were treated with insulin glargine or NPH insulin for 24 to 36 weeks

The researchers found that hemoglobin A1c (HbA1c) levels were significantly reduced over time for both men and women (P < 0.001), with a significantly greater decrease in HbA1c for men versus women (−1.36 versus −1.22; P = 0.002). Target HbA1C <7 percent was achieved by significantly fewer women (P < 0.001). Women had a significantly higher insulin dose/kg than men at the study end (0.47 versus 0.42 U/kg; P < 0.001). In women, the incidence rates of severe hypoglycemia and severe nocturnal hypoglycemia were significantly higher (P < 0.05 and P < 0.001, respectively). Women were significantly more likely to experience severe hypoglycemia and severe nocturnal hypoglycemia (odds ratios, 1.80 and 3.80, respectively).

These observations confirm studies that found a smaller improvement in HbA1c and greater hypoglycemia in women during insulin treatment. Physicians should be aware of the need to determine and closely monitor dosing, particularly in women, to optimize the balance between glycaemic control and hypoglycemia risk.

Practice Pearls:

• Women were significantly more likely to experience severe hypoglycemia and severe nocturnal hypoglycemia.
• Women had a significantly higher insulin dose/kg than men
• Men had a significantly greater decrease in HbA1c.

Kautzky-Willer A. Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab. 2015 Jun;17(6):533-40. doi: 10.1111/dom.12449. Epub 2015 Mar 20.