Sex-based disparities in type 1 diabetes onset in pediatric care

A review of more than 90 published studies found that sex-based disparities in type 1 diabetes care in the pediatric population may contribute to differences in outcomes between male and female patients.

Leveraging data from more than 640,000 pediatric patients with type 1 diabetes, the study results indicate that differences in the clinical care of children and adolescents with type 1 diabetes, particularly in glycemic control, insulin dosing, and weight management, may play a role. Higher mortality and excess cardiovascular risk observed among female population with type 1 diabetes.1

“This systematic review of gender differences in children with type 1 diabetes showed that many outcomes appear to be worse in the female sex compared to their male counterparts, particularly BMI, glycemic control, [insulin dose]Diabetic ketoacidosis and [quality of life]” wrote the researchers.

Despite progress and emphasis on research and new initiatives, existing data underscore clear disparities in the care of women with diabetes compared to their male counterparts. In September 2022, data from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications study found that women with type 1 diabetes had a lower burden of cardiometabolic risk factors, received less aggressive cardioprotective medications, but experienced a similar burden of cardiovascular events. Rate as male.2

Citing these disparities in outcomes, a team led by Sylvia de Vries, MD, MSc, of the University of Amsterdam Medical Center, launched the current study to provide an overview of gender differences in children with type 1 diabetes, with a particular focus on the patient. and disease characteristics, treatment, comorbidities, and complications. To do so, the researchers designed a systematic review to include observational cohort, cross-sectional, and case-control studies published within MEDLINE from inception to June 15, 2021.

From their search, the researchers identified 8640 articles for potential inclusion. Of these, 90 studies involving a total population of 643,217 individuals with type 1 diabetes were identified for inclusion in the systematic review. For inclusion, studies needed to have a primary outcome that noted a gender difference in outcome. For the purpose of analysis, articles reporting gender differences were identified and assessed for quality and risk of bias.

In the analysis, the results indicated that most studies showed that female children had higher HbA1c during clinical diagnosis and treatment. Results indicated that HbA1c increased over time in female children as well. In studies reporting BMI, results suggested that female patients with type 1 diabetes had a higher BMI, a higher prevalence of overweight or obesity, and a higher prevalence of dyslipidemia than their male counterparts.

Further analyzes revealed that female patients with type 1 diabetes used pump therapy more often, required higher insulin doses, and were hospitalized more often than their male counterparts. These analyzes revealed that male patients with type 1 diabetes were more likely to experience hypoglycemia, partial remission, and diabetic ketoacidosis than their female counterparts. The researchers noted several other notable results from their analysis, including a lower quality of life in female patients with type 1 diabetes, which was observed in all studies reporting on quality of life.


1. de Vries SAG, Verheugt CL, Mul D, Nieuwdorp M, Sass TCJ. Do sex differences exist in pediatric type 1 diabetes care? A systematic review – diabetes science. SpringerLink. Published on January 26, 2023. Accessed February 2, 2023.

2. Campbell P. Despite improved risk profiles, women with type 1 diabetes have increased CVD risk. Endocrinology Network. Published on September 8, 2022. Accessed February 2, 2023.

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