Girls with type 1 diabetes have worse outcomes compared with boys
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Compared with boys, girls with type 1 diabetes have worse HbA1c, higher BMI and more diabetic ketoacidosis and require higher insulin doses, according to a systematic review published in Diabetologia.
“The observed disparities between sexes ... in our study populations can partially be attributed to puberty, yet this does not explain potential disparities in younger children,” Silvia A. G. de Vries, MD, PhD, from the department of vascular medicine at the Amsterdam University Medical Center, and colleagues wrote. “Factors that may play an important role at prepubertal ages are differences in the distribution of fat, insulin resistance, behavioural factors, growth hormone and the early influence of sex steroids. Treatment bias to the disadvantage of young girls may also influence daily clinical care, potentially affecting the treatment of risk factors.”
Researchers searched literature in MEDLINE up to June 2021 and identified 90 observational, cohort, cross-sectional and case-control studies with 643,217 people that included assessment of diabetes, sex characteristics, sex distribution and children and/or adolescents with type 1 diabetes for review. All studies’ primary outcomes mentioning sex differences among children with type 1 diabetes were included.
Most studies observed a higher HbA1c for girls at diagnosis and during treatment compared with boys. In addition, these studies demonstrated a steeper HbA1c increase over time among girls. Many studies also observed higher BMI, a higher prevalence of overweight or obesity and a higher prevalence of dyslipidemia among girls.
For boys, hypoglycemia and partial remission occurred more often whereas diabetic ketoacidosis and hospitalization occurred more often among girls. Most of the studies’ findings demonstrated that girls used pump therapy more frequently and needed higher insulin doses compared with boys.
Researchers also observed comorbidities, including thyroid disease and celiac disease, as more common among female participants compared with males. Every study reported lower quality of life among female participants.
According to the researchers, the large number of studies reporting comparable outcomes favoring one sex over the other within several clinical categories renders this evidence increasingly convincing.
“Sex disparities are observed in a variety of daily clinical variables and outcomes in the pediatric type 1 diabetes population, specifically among female adolescents. Most striking differences are seen regarding glycemic control, BMI, insulin dose, DKA and quality of life,” the researchers wrote. “These differences suggest a less favorable clinical profile for young female individuals, with potential consequences later in life.”
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