Does good management of type 2 diabetes depend on gender?

The study investigated the outcome of patients treated with alternative type 2 diabetes mellitus therapies based on gender.

Type 2 diabetes mellitus (T2DM) is a disease that results in hyperglycemia (high blood sugar) due to a lack of insulin (protein that controls blood sugar levels) or due to insulin resistance (body does not respond to the insulin produced). Treatment of T2DM is based on providing insulin, anti-diabetes drugs and changes to a patient’s diet.

Gender is thought to be an important factor in insulin resistance and studies have shown that women have poorer glycemic control (control of blood sugar levels) when compared to men.

Although females appear to have better utilization of health care services, diet, and rate of blood sugar monitoring, they have a reduced ability to reach glycated hemoglobin (HbA1c) goals (goals for average blood glucose levels) when compared to men. One reason for this reduced ability to meet HbA1c  levels is thought to be related to their naturally lower level of counter-response to hypoglycemia (low blood sugar levels).

This study aimed to examine patient’s outcomes when treated with insulin glargine (Lantus; long acting insulin taken to provide a small level of insulin all day) or alternative therapies, for example; insulin lispro (Humalog; a fast-acting insulin usually taken after meals) or dietary intervention. The study investigated the effects of gender on glycemic control, insulin dose, and rates of hypoglycemia.

2,938 patients were included in this study. 49.8% were treated with insulin glargine and 50.2% with alternative therapies. The study investigated the number of patients reaching a HbA1c level of 7.0%, fasting plasma glucose (100 mg/dL; the levels of glucose following a period with no food or drink), patient weight, insulin dose and rates of hypoglycemia. 

A higher proportion of males (60.8%) treated with insulin glargine achieved HbA1c 7% goals when compared to females (54.3%). When evaluating alternative therapies there was no significant differences between the percentage of males achieving HbA1c levels of 7% (51.3%) and females reaching similar levels (52.7%). Patient weight was shown to increase in both genders regardless of therapy.

All forms of hypoglycemia were more common in females when compared to male. Females treated with insulin glargine were shown to be less likely to experience hypoglycemia than females on alternative therapies.

The study concluded that gender was a factor the health care provider should consider when using glucose-lowering agents.

Patient post-meal data was not examined; therefore the amount or type of food being consumed was never accounted for. Carbohydrates are essential sources of sugar; a low carbohydrate diet could result in hypoglycemia.