Women and Diabetes

Type 2 diabetes has an equal prevalence in men and women. In many studies, the relationship between BMI and diabetes incidence is stronger in women than in men. The relative risk conferred by diabetic status differs between genders. Diabetes is a powerful risk factor for cardiovascular disease, and the overwhelming majority of excess deaths in diabetes are from cardiovascular causes. In women, is an even stronger cardiovascular risk marker than in men. In fact, diabetes erases the survival advantage of the female gender, so that men and women with diabetes have similar risk of cardiovascular disease and death. The higher relative risk of diabetes in women is not explained by any known risk factor and the cause is currently unknown.

After menopause, the risk of diabetes rises along with body weight. Contrary to expectations, however, menopause or hormonal status have no impact on the incidence of diabetes. Instead, age is the primary factor in diabetes after menopause, with lesser contributions from body weight and waist circumference. There does not appear to be a direct role of sex hormones in the onset of diabetes in women.

Gestational diabetes is a powerful risk factor for the later development of Type 2 diabetes. Women who have had gestational diabetes are strong candidates for diabetes prevention, by increased physical activity and a diet rich in plant based foods. A comparable early warning marker is absent for men. The use of antidiabetic drugs postpartum, particularly the insulin sensitizing agent metformin, may have a role in preventing diabetes in this high risk population.

Polycystic ovary disease is a reproductive syndrome marked by excessive androgens in women, leading to reduced fertility and insulin resistance. The syndrome greatly increases the risk of diabetes. While polycystic [Page 801]ovary disease is associated with obesity, at least part of the weight gain is the result of syndrome of insulin resistance, which leads to compensatory increases in insulin secretion thereby promoting further weight gain. Metformin, by reducing insulin resistance, can be effective in countering the syndrome and in favoring weight loss. While polycystic ovary disease increases multiple risk factors for coronary heart disease, the actual increase in cardiovascular events is small or even absent. The reason for this paradox is not clear, but the contribution of polycystic ovary disease to diabetes risk is a major concern.

Gestational diabetes is a warning for the later development of Type 2 diabetes. A comparable early warning marker is absent for men.