Does diabetes affect women differently from men?

Diabetes currently affects an estimated 4.6 million people in South Africa and around half of these people are women. While diabetes affects women and men in almost equal numbers, diabetes affects women differently from men.

“The burden of diabetes on women is unique, because the condition can affect women both as adults and as potential mothers of their unborn children,” says Dr Larry Distiller, Specialist Physician/Endocrinologist and Principal Physician, and Executive Chairman of the Centre for Diabetes and Endocrinology (CDE). Uncontrolled diabetes can cause difficulties during pregnancy such as a miscarriage or a baby born with birth defects. When compared to women without diabetes, women with diabetes have a higher risk for heart disease and are more likely to have a heart attack at a younger age with a lower survival rate and poorer quality of life after a heart attack. They also have a higher risk for blindness and a higher risk for depression. “Depression, which affects twice as many women as men, also raises the risk for diabetes in women,” notes Distiller.

“Whilst it is absolutely possible to live a long, healthy and purpose-filled life with diabetes, the condition will need your constant attention. Diabetes is a chronic condition – it does not go away. This means that its presence in your life may span a number of developmental or life stages, each with its own challenges apart from the demands of diabetes self-care,” says Distiller.

As August is Women’s month, CDE provides some useful guidelines on how diabetes can provide additional challenges for women over a lifespan.

Adolescent Years (10-17 Years)

Most young women in this age group have type 1 diabetes. In the management of type 1 diabetes, there is a large focus on food as carbohydrates need to be ‘counted’ to determine appropriate insulin dosages. This can lead to an abnormal relationship with food. Young women with diabetes face a higher risk versus young women in the general population of developing an eating disorder such as bulimia or anorexia nervosa.

There is an apparent increase in the number of youth of all racial and ethnic groups being diagnosed with type 2 diabetes, and it appears to be more common among women than men, possibly because of higher rates of obesity and being overweight in this gender.

By age 20 years, 40% to 60% of people with type 1 diabetes have evidence of eye disease (retinopathy), which if left untreated can lead to blindness. This risk is higher for women than for men.

Reproductive Years (18-44 Years)

Many women of reproductive age have diabetes (mostly, but not exclusively, type 2 diabetes) and about half of these women do not even know they have the condition.

Most gestational diabetes occurs in women with risk factors for type 2 diabetes; they are unable to secrete sufficient insulin to overcome the increased insulin resistance that normally results as pregnancy proceeds.

Gestational diabetes usually ends after the baby is born, but women with gestational diabetes have a 20%-50% chance of developing type 2 diabetes in the 5-10 years after childbirth.

For women who do not currently have diabetes, pregnancy brings an increased risk of gestational diabetes, particularly in women who are overweight or obese. Gestational diabetes affects about 1 in 7 births globally, and may persist as type 2

diabetes or ‘pre-diabetes’ or resolve completely when a pregnancy is over. Women who have had gestational diabetes are at an increased risk for developing type 2 diabetes later in life.

Children whose mothers had diabetes during their pregnancies have a greater likelihood of becoming obese during childhood and adolescence and of developing type 2 diabetes later in life. For women with babies or young children, diabetes management is particularly challenging. Focus shifts away from themselves towards their children and routines are often disrupted, making it challenging to maintain conscientious diabetes management. Simple tasks like self-monitoring of blood glucose are often neglected.

Middle Years (45-64 Years)

Coronary heart disease is an important cause of illness among middle-aged women with diabetes; rates are three to seven times higher among women 45-64 years old with diabetes than among those without diabetes.

Older Years (65 Years and Older)

Most older women with diabetes have type 2 diabetes and again, many are unaware of the condition.

Because women with diabetes live longer than do their male counterparts, elderly women with diabetes, outnumber older men with the condition. Many women also outlive their spouses. For older women with diabetes, this creates an additional challenge of having to manage the condition alone.

Older women with diabetes are at particularly high risk for coronary heart disease, visual problems, hyperglycaemia (high blood glucose), hypoglycaemia (low blood glucose), and depression.

“Diabetes poses challenges for women at all stages of life, but with good support from their diabetes care team, it is possible to achieve good control of the condition and to minimise any potential risks,” concludes Distiller.