Type 2 diabetes affects men and women in different ways. There may be a number of reasons for this.

Type 2 diabetes is the most common type of diabetes. Of the 34 million people with diabetes in the United States, an estimated 95% have type 2 diabetes.

In type 2 diabetes, the cells of the body become less responsive to insulin, which is the hormone responsible for regulating blood sugar levels. Higher doses of insulin are necessary to overcome this resistance.

However, this can lead to rising blood sugar levels, which can result in damage to the:

  • heart
  • eyes
  • kidneys
  • nerves

Because diabetes has such widespread effects throughout the body, it can affect men and women differently.

According to the Centers for Disease Control and Prevention (CDC), men are more likely to receive a diagnosis of diabetes than women. However, some research suggests that women with diabetes may be more likely to develop complications than men.

Here are some of the different ways that type 2 diabetes affects men and women and potential reasons for these differences.

Men are almost twice as likely to develop type 2 diabetes as women.

Having overweight or obesity is considered a primary risk factor for diabetes. However, obesity rates are similar between men and women in the U.S. This suggests that the relationship between sex, weight, and diabetes may be more nuanced.

Some research suggests that where people carry fat may help explain the differences in diabetes rates between the sexes. For example, men have larger amounts of visceral (mostly abdominal) fat than women. Women tend to have more subcutaneous (mostly leg and hip) fat than visceral fat.

Visceral fat tends to be more metabolically active than subcutaneous fat, meaning that the fat itself produces hormones that can affect a person’s health. Having more visceral fat is strongly linked to having a higher risk of metabolic syndrome, including type 2 diabetes.

Women with obesity are also more likely than men to be metabolically healthy. In other words, they have normal blood sugar levels without hypertension or elevated cholesterol. This may explain why men may develop type 2 diabetes while women with the same body mass index (BMI) do not.

Some research suggests that differences in certain behaviors may also contribute to differences in the prevalence of diabetes. These behaviors include:

  • sugar intake
  • dietary patterns (eating more fruits and vegetables and less meat)
  • alcohol consumption
  • smoking habits

Once women develop type 2 diabetes, they have a higher likelihood of experiencing complications from the condition than men. These complications include:

Some research suggests that women are more proactive than men about managing their type 2 diabetes, suggesting that biology may increase the rate of complications.

One theory is that sex hormones may play a role. Female sex hormones, including estrogen, may play a protective role against many conditions, including heart disease and kidney disease.

High blood sugar in uncontrolled diabetes impairs the body’s response to estrogen. This reduces the protective effects of female sex hormones. In other words, diabetes complications in women may be linked to both the effects of high blood sugar and the reduced effects of estrogen signaling on the body.

Women with type 2 diabetes are also more likely to experience depression than men. Depression can affect the frequency and severity of type 2 diabetes complications. One 2020 study found that depression increased the likelihood of type 2 diabetes-related hospitalizations by over 50%.

Type 2 diabetes can affect sexual health. Many of the risk factors for diabetes, including obesity and high blood pressure, can also increase the risk of sexual dysfunction.

High blood sugar can play a role, too. Elevated blood sugar levels can cause damage to blood vessels and nerves. This can affect sexual health.

In men, proper blood flow and nerve activity in the penis are necessary to maintain an erection. High blood sugar can damage these sensitive systems. As a result, men with diabetes are three times more likely to experience erectile dysfunction than the general population.

Type 2 diabetes also impacts women’s sexual health. In one 2015 study, over 78% of women with type 2 diabetes reported some form of sexual dysfunction, including:

  • vaginal dryness, which can cause uncomfortable or painful sex
  • reduced sex drive
  • difficulty with sexual arousal or achieving orgasm
  • low sexual satisfaction

These problems may also have to do with impaired estrogen signaling due to high blood sugar levels. It may be exacerbated in menopause, when changes in hormone levels impact vaginal dryness and sexual health.

Poor circulation and high blood sugar can also make it difficult for the body to fight off infections. This can increase the risk of urinary tract infections and yeast infections in women with type 2 diabetes.

High blood sugar can also increase the risk of pregnancy-related complications in women with uncontrolled type 2 diabetes, including the risk of:

  • high blood pressure, or preeclampsia
  • cesarean delivery
  • miscarriage or stillbirth

Anyone with type 2 diabetes who is pregnant or planning to become pregnant should work closely with their healthcare team to ensure that their blood sugar levels are well controlled.

Although sex differences may play a role in type 2 diabetes, treatment guidelines remain the same for both men and women. Future research may focus on understanding if and how treatments should be sex-specific.

For now, the goal of type 2 diabetes treatment is to maintain safe blood sugar levels to minimize the risk of complications. The approach to treatment should be personalized based on each individual’s needs, including their current blood sugar levels and risk of complications.

Certain treatment options are better for people with heart or kidney disease and for those who are at increased risk of these complications. Some treatments may even help protect against heart disease. Other anti-diabetes medications may actually increase the risk of heart disease.

A person’s healthcare team will help create a personalized treatment plan based on their current health as well as their risk of complications.

Diabetes involves systems throughout the body, thereby impacting men and women differently.

Men are more likely to develop type 2 diabetes. Women are more likely to experience complications, including heart and kidney disease. The effects of high blood sugar and reduced hormone signaling can also impact sexual health in both men and women.

It is important for people with diabetes to work closely with their healthcare team to ensure that they successfully manage diabetes and any complications that may arise.