Venus and Mars: influence of sex on diabetes and cardiometabolic disease

The latest estimates for global diabetes prevalence will no doubt concentrate the thoughts of healthcare officials in many countries [1]. Global age-standardized diabetes prevalence increased from 4.3% (95% credible interval 2.4–7.0) in 1980 to 9.0% (7.2–11.1) in 2014 in men, and from 5.0% (2.9–7.9) to 7.9% (6.4–9.7) in women. Thus, over a quarter of a century, the prevalence of diabetes more than doubled in men. The increase seen in women was less pronounced at 60%. These data are consistent with other reports that support a shift from an excess prevalence in women in the earlier part of the 20th century to a consistently higher male prevalence [2,3]. The male predominance in type 2 diabetes has implications for cardiometabolic disease prevention strategies that extend to population screening. For example, in the Rancho Bernardo Study, more women than men had isolated postchallenge (oral glucose tolerance test) hyperglycaemia as the only evidence of diabetes; the incidence of diabetes was higher in men than in women, with higher fasting but lower postchallenge glucose levels compared with women [3]. The prevalence of prediabetes syndromes – that is, impaired fasting glucose and impaired glucose tolerance – also differs by sex, with impaired fasting glucose being more prevalent in men and impaired glucose tolerance being more frequent in women [4].