Analysis of the national diabetes audit results indicates that younger women with type 2 diabetes (T2D) appear to experience a higher mortality rate compared to men. But why?

The European Association for the Study of Diabetes (EASD) in Hamburg is set to discuss a groundbreaking study suggesting a reevaluation of the diagnostic criteria for Type 2 Diabetes (T2D) in women under 50.

Published in the Diabetes Therapy journal, the study by Dr. Adrian Heald and his team from Salford Royal Hospital, UK, points out that menstruation may impact blood sugar management.

Recent national audit data reveals that younger women with T2D face a higher risk of mortality than their male counterparts. One reason might be the average later diagnosis of T2D in women.

While the exact mechanisms remain a mystery, data indicates that women tend to receive a Type 2 Diabetes (T2D) diagnosis later in life than men. This recent study explores if menstrual blood loss, impacting haemoglobin levels, could play a role in this delay.

This unique angle suggests that shorter lifespans of red blood cells, due to menstruation, might lead to less haemoglobin exposure to glucose. Given that T2D diagnosis largely depends on glycated haemoglobin (HbA1c) levels, using a universal reference range for both genders might skew results, particularly for premenopausal women. This could inadvertently result in fewer T2D diagnoses in women, leaving potential treatment opportunities untapped.

For this investigation, HbA1c tests from seven distinct UK labs were analyzed. In the first cohort from a single lab, spanning 2012-2019, the gender and age differences in HbA1c were studied in participants undiagnosed with diabetes.

This approach was mirrored in the second cohort, which incorporated results from six labs between 2019 and 2021. Extrapolating these findings to national statistics offers a glimpse into the broader implications for the UK populace.

The research revealed that, by age 50, women’s HbA1c levels tend to trail those of men by roughly five years. Moreover, women below 50 exhibited HbA1c readings lower than their male counterparts by an average of 1.6 mmol/mol.

Subsequent analysis indicated that using the current HbA1c threshold, significantly fewer women under 50 could be diagnosed with T2D compared to men of the same age bracket.

Taking these findings into account, adjusting the diagnostic criteria could lead to an additional 35,345 women under 50 in England being identified with T2D. This would allow early interventions, potentially altering the trajectory of their health.

Moreover, gender disparities in cardiovascular risks, even prior to T2D diagnosis, are evident. Post-diagnosis, the risk doubles, with women aged 35-59 facing the highest cardiovascular mortality risks amongst all groups.

Despite this, women with T2D often face unequal treatment opportunities. They’re less likely to be prescribed vital medications, like statins and aspirin. In essence, a prompt T2D diagnosis and subsequent treatments could significantly improve the longevity and quality of life for women.

This study underscores the urgent need to reconsider the current HbA1c diagnostic guidelines for younger women.

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