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Why Diabetes Hits Women Harder Than Men

Studies show diabetes affects women more severely than men. So why aren’t we talking about it more?

At first glance, it might seem like men are harder hit by cardiometabolic disease, in particular diabetes. The prevalence of Type 2 diabetes is 14.6% among men and 9.1% among women.  Even though more men have diabetes, women are at higher risk for serious complications and death. Women also face unique obstacles to effective treatment of their diabetes ranging from hormonal to environmental barriers.

Hormones and a toxic environment cause a “perfect storm”

At three key points in their lives, female hormones cause a unique environment that predisposes women to additional weight gain and/or diabetes: puberty, the 20s to 30s and menopause.

Puberty is when girls are supposed to gain weight as a natural part of development.  But for girls who enter puberty overweight or obese, puberty can come earlier. And, once puberty starts, the interplay between estrogen, leptin, and insulin can put girls at high risk for weight gain above what is expected - especially in the presence of environmental risk factors. At this age, girls in the U.S. are more likely to adopt unhealthy habits such as reduced exercise and unhealthy food choices.

But the most rapid weight gain for women occurs in the 20s to 30s when US adults gain on average 17 pounds, with women gaining more than men. In addition to shared risk factors with men such as lifestyle change and stress, women can also become pregnant during this time.

Pregnancy can impact women's diabetes risk. Ten percent of all U.S. pregnancies are affected by gestational diabetes, a type of diabetes that happens only during pregnancy.

Half of women with gestational diabetes go on to develop type 2 diabetes. Of the female population in Omada’s Type 2 Diabetes program, 6% have reported previously having gestational diabetes.

Like pregnancy, menopause can also worsen diabetes complications. After menopause, women can experience a drop in estrogen, which can lead to unpredictable blood sugar levels or weight gain, increasing the likelihood of comorbid obesity, and the need for insulin or other diabetes medicines.

*Source: 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

Women are more prone to comorbidities

Women with diabetes are more likely than men to have multiple complications, called comorbidities. Diabetic retinopathy is a complication of diabetes caused by high blood sugar that damages blood vessels in the retina. It’s the leading cause of blindness in working-age U.S. adults, however women are more at risk for diabetes-induced blindness, in part because pregnancy can worsen diabetic retinopathy.

Women also have a higher risk for heart disease, the most common complication of diabetes. Pre-menopausal women with diabetes lose the protection against heart disease that non-diabetic women have, and are 50% more likely to die from heart disease than men. One study showed that a staggering 36.9% of women with diabetes who had a heart attack died within a year, compared to 20.2% of women without diabetes.

The overall risk for fatal coronary heart disease associated with diabetes is 50% higher in women than in men.

Women are also more likely to experience stress, depression and obesity, all of which raise the risk of diabetes and make effective management more difficult.

Despite these increased risk factors, healthcare institutions historically haven’t responded with the requisite urgency. In high-income countries around the world, women are consistently more likely to receive less intensive care and treatment for diabetes.

Though women may not be at higher risk for cardiometabolic disease, they are at higher risk for complications once diagnosed. The combination of genetics, hormones, pregnancy and caregiving roles compound this risk.  In particular, the crushing responsibilities of caregiving contribute to women having worse outcomes once diagnosed.

Racial and ethnic disparities

Perhaps unsurprisingly, research shows that certain ethnic and racial groups of women have it even worse than their white women counterparts in virtually all aspects of healthcare.

According to a Kaiser Family Foundation survey, significant disparities are seen across health status, insurance coverage rates, access to physicians, use of preventive services, dealing with health care costs, transportation and childcare availability. Unfortunately, the issue of diabetes risk and outcomes is more of the same.

Generally, American Indian/Alaska Native, Black, Latina and Asian women are more at risk for developing diabetes and serious complications than white women — and different communities experience diabetes differently. For example, American Indian/Alaska Native women actually have the highest rate of diabetes among all racial and ethnic groups in the United States. This demographic is also more than twice as likely to die from diabetes compared to their white women counterparts.

According to the U. S. Department of Health & Human Services Office of Minority Health, diabetes is almost twice as common in non-Hispanic Black women and Mexican-American women compared to white women. For Asian or Pacific Islander women in the United States, diabetes is the fifth-leading cause of death. It’s also more common for Asian or Pacific Islander women to develop gestational diabetes compared to white women.

Women face barriers to effective treatment

In addition to the above risk factors, women also have a harder time receiving the right treatment for diabetes due to limited research and awareness.

Change begins with understanding. But it’s hard to understand anything, particularly in the medical field, without studying it.

In the case of women’s health and diabetes—not to mention, women’s health more broadly—the research has long been lacking.

For most of history, medical researchers have treated men and women as interchangeable, favoring men’s health for funding and men’s bodies for study. Even today, only about a third of participants in clinical trials to develop new treatments for cardiovascular disease––the number one killer of women in the U.S. and a common diabetes complication––are female. This persists despite our collective understanding that biological sex differences affect the treatment and ensuing outcomes of many diseases, particularly for noncommunicable diseases, like diabetes, which account for 74% of deaths globally.

That’s not to say progress isn’t being made. Many organizations now study sex and gender in biomedical research, which has helped yield important findings about the unique diabetes risk factors women face. We now know that a host of hormonal and genetic risk factors affect women at higher rates than men.

Women’s health impacts everyone

The lack of awareness and underfunding of women’s health issues not only impacts women; it impacts everyone.

Studies by organizations like Women's Health Access Matters have run simulations to examine what stepping up investments in certain women’s health issues would do. The results are eye opening.

Conservative estimates showed that increasing research funding for women’s health issues would dramatically increase life expectancy for women, give women more productive caregiving years, ease burdens on overwhelmed health institutions like nursing homes, and add tens of billions, if not hundreds of billions of dollars, back into our economy. Wall Street and investors should take notice, too. By doubling the NIH budget for research on coronary artery disease in women, which is a common diabetes complication for women, we’d see an expected ROI of 9,500%.

Healthcare professionals, medical researchers, and other stakeholders should view understanding the complex intersection of women’s health and diabetes as an opportunity. There’s an opportunity to improve lives, improve society, and improve our collective economic reality by getting more women into the field of diabetes research, funding more studies for women with diabetes, including more women in clinical trials, expanding virtual care delivery models, and increasing female representation at healthcare institutions.

Innovation offers new opportunities

Since one the biggest barriers to treatment is access, technology offers an opportunity to reach women in new ways for key interventions like lifestyle change, medication titration, and behavioral health support.

Virtual care is more convenient and saves time, which is uniquely attractive to women who are caregivers. And virtual care, done right, is proven to lead to behavior changes that improve risk for cardiometabolic disease.

Since 80% of healthcare decisions are made by women, the attraction of virtual care for women makes them key stakeholders in this new market.  Meeting women’s needs in this emerging field not only makes sense for their health, but also the bottom line.

After 12+ years of providing virtual care for cardiometabolic disease for hundreds of thousands of people, Omada has garnered key insights into the potential of virtual care for women. Across the board, women are significantly more engaged in our programs than men. In fact, 89.1% of members in Omada's Healthy with Kids community are women, and Omada members and coaches talked about menopause more than 1,000 times since March 2023 alone.

Imagine the impact women might feel if employer-sponsored and provider-sponsored health coverage included comprehensive virtual care services. What if those virtual care programs went a step further and specifically focused on key women’s health issues like diabetes?

That’s exactly what we’re doing at Omada Health.

We’ve taken steps to tailor elements of our organization and our clinical programs, which includes the first virtual NCQA-accredited diabetes program, which allows for flexibility in meeting the unique needs of the various subsets within our patient population.

We’ve made representation a major point of emphasis. Despite their influence as healthcare consumers as mentioned above, women are overwhelmingly under-represented in the industry's leadership. Women comprise 30% of C-suite teams and just 13% of CEOs. To meet the moment, we’ve bolstered our leadership ranks with more women to address equity in executive decision making. We’ve also scaled up the hiring of more female Certified Diabetes Care and Education Specialists (CDCES) and health coaches.

On the clinical front, we’ve woven behavioral health services into our diabetes program to tackle mental health risk factors women are more likely to face and integrated physical therapy to address functional challenges. Still, there’s more we can do and we’re working on it.

Change is happening

It’s undeniable that the issue of worse diabetes outcomes for women, and even worse outcomes for American Indian/Alaska Native, Black, Latina and AAPI women, is indicative of an underachieving health system, but also of a broader societal context. Women are more likely than men to encounter pay disparity, sexual harassment, or a steeper climb up the organizational ladder.

With more understanding thanks to media coverage, legal action, policy reform, and organizational buy-in from leadership across industries, we’re seeing real change. Despite very public setbacks, society continues to trend in the right direction when it comes to how we treat and support women in the workplace, in media representation, and beyond. We can and must continue to improve, but it’s clear that understanding leads to change — especially when it comes to the many nuances of women's health.


This Proof Points edition was originally published on LinkedIn on 5/11/23.