Special Considerations in the Management of Diabetes in Women.

Abstract

Type 2 diabetes and prediabetes are heterogeneous diseases that directly affect over 115 million Americans. Considerable gender differences exist with regard to diabetes risk factors, hormonal effects on glucose, and cardiovascular outcomes.Historically, diabetes studies have largely focused on men with the assumption that the data can safely be extrapolated to women. However, more recent investigations have illuminated significant differences between genders.Women are at higher risk of death from cardiovascular disease (CVD), are more likely to die following a myocardial infarction, and are treated less aggressively toward glycemic targets. Additionally, pregnancy and menopause have profound effects on the risks for diabetes and therefore warrant more aggressive diagnostic attention and monitoring. It is important for practitioners to understand that women who have gestational diabetes are at an increased risk for CVD even if they do not develop diabetes. Older age brings additional challenges with diabetes, including increased fracture risk even with normal bone mineral density.Recognizing the stages of life that are unique to women is critical as treatment and patient education can significantly impact patient well-being and outcomes. This article describes female-specific characteristics of prediabetes and diabetes during several distinct phases of life, including pregnancy, menopause, and older age. Diagnostic and management strategies for these populations are also discussed.