14/11/2020
There are currently over 199 million women living with diabetes, and this is projected to increase to 313 million by 20401. Diabetes is the ninth leading direct cause of death in women globally, causing 2.1 million deaths each year, most of them were pre-mature1. The issue of women and diabetes is important for several reasons.
Diabetes impacts women more severely
Although diabetes affects men and women equally, women are more severely impacted by its consequences. Pre-menopausal women with diabetes lose the protection against heart disease that non-diabetic women have2 and are 50 per cent more likely to die from heart disease than men3,4,5,6. A study showed that 36.9 per cent of women with diabetes with a heart attack died within a year, compared to 20.2 per cent of women without diabetes7. Compared to men, women are also at a greater risk of blindness due to diabetic retinopathy8. Women, with type 1 diabetes, are more likely to suffer from retinopathy and neuropathy9. Pregnancy may worsen pre-existing diabetic retinopathy and lead to significant visual impairment. Pregnancy may also worsen pre-existing kidney disease. Elderly women with type 2 diabetes mellitus (T2DM) and end-stage renal disease have a significantly higher risk of death than men with similar problems10. Women with diabetes are four times more likely to suffer a stroke than women without diabetes11. Cyclical hormonal changes make diabetes control more difficult in pre-menopausal women, and the risk of diabetic ketoacidosis is higher amongst women than men. Women are also consistently more likely to develop depression than men12. While the higher burden of cardiovascular and other complications in women with diabetes may be due to biological reasons, it is also a fact that, in all countries including the high-income economies, women tend to receive less intensive care and treatment for diabetes compared to men3,13,14.
Women also develop hyperglycaemia in pregnancy (HIP) which significantly increases the risk of maternal and perinatal morbidity and mortality and pregnancy complications: hypertension and pre-eclampsia, obstructed labour, postpartum haemorrhage, infections, stillbirths, pre-mature delivery, both large and small for gestational age (SGA) infants, congenital anomalies, newborn deaths due to respiratory problems, hypoglycaemia and birth injuries. The risk and number of these complications are directly related to level of maternal hyperglycaemia15,16. Apart from pregnancy complications and poor outcome, HIP increases the vulnerability for future T2DM and is the most reliable marker of future T2DM17 and cardiometabolic disorders in women18; with a proven possibility of prevention or delaying onset through appropriate post-partum lifestyle interventions19,20,21.
Gender not only influences the vulnerability to disease but also affects access to health services and health-seeking behaviour for women22 which may amplify both the short- and long-term adverse impact of diabetes. In low-income countries, women suffer disproportionately from economic, political and social discrimination, and consequently from poor health, lack of education and employment23. Stigmatization and discrimination faced by people with diabetes are particularly pronounced for girls and women, who carry a double burden of discrimination. Lack of education restricts access to information; restriction of free movement or need to be accompanied by an es**rt or fear of being shunned in marriage or abandonment and divorce if diagnosed with diabetes are important barriers24 which discourage girls and women from seeking diagnosis and treatment and receiving adequate care, resulting in more complications and less likelihood of achieving positive health outcomes.
