A large meta-analysis involving more than 200,000 participants has found that women with type 1 diabetes have more than twice the risk of dying from heart disease compared with men who have the condition.

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Poorer glycemic control and insulin management – which the authors say are more common among women than men – could be contributing factors to women’s raised risk of death.

In type 1 diabetes, the pancreas does not produce sufficient levels of insulin to convert sugars, starches and other foods into energy.

Currently, around 15,000 children and 15,000 adults are diagnosed with type 1 diabetes every year in the US, costing the health care system an annual $14.9 billion.

Type 1 diabetes is becoming more common all over the world, too. The incidence of type 1 diabetes in children aged 14 years and younger has risen globally by 3% every year since 1989.

In the new study, published in The Lancet Diabetes & Endocrinology, researchers from the School of Public Health at The University of Queensland in Australia conducted a meta-analysis of all studies to examine sex-specific estimates of type 1 diabetes mortality between 1966 and 2014. In total, the team analyzed 26 studies that involved 214,114 participants with type 1 diabetes.

The study found that women with type 1 diabetes had a 37% higher excess risk of death from any cause compared with male type 1 diabetes patients. Female type 1 diabetes patients were also found to have nearly twice the risk of dying from cardiovascular disease than men, a 37% increased risk of stroke and a 44% increased risk of death from kidney disease.

However, the researchers were interested to find that type 1 diabetes does not appear to be associated with an increased risk of death from cancers in men or women.

Speculating on the reasons for the increased risks among female type 1 diabetes patients, the authors suggest that poorer glycemic control and insulin management – which the team says are more common among women than men – could be contributing factors.

“We know that people with type 1 diabetes have shorter life expectancies than the general population, from both acute and long-term diabetic complications. But until now, it was not clear whether this excess risk of mortality is the same in women and men with the disease,” explains Rachel Huxley, lead author.

“A key question is how the risk of excess mortality in women can be reduced further – a particular challenge given that the reasons for excess mortality in type 1 diabetes are still unclear,” writes David Simmons, from the University of Western Sydney in New South Wales, Australia, in a linked comment.

Simmons says that reducing type 1 diabetes mortality rates will require additional expenditure. However, the benefits of this spending boost may not be felt for up to 2 decades:

The additional investment in the diabetes specialist and mental health services to be able to give the additional time that patients need, and into modern technology that can help reduce hyperglycemia while avoiding hypoglycemia and fear of hypoglycemia, must start now.”