Key result
Females with type 2 diabetes had significantly higher odds of cardiovascular disease, retinopathy, nephropathy, and depression compared to males across multiple age groups (all p<0.001).
Why the study?
Sex differences in macrovascular complications of type 2 diabetes are known, but evidence on microvascular differences remained limited.
Are there sex differences in the odds of macro- and microvascular complications among patients with type 2 diabetes?
Observational (n=8,900,000)
Yes
Are there sex differences in the odds of macro- and microvascular complications among patients with type 2 diabetes?
p-value: p=<0.001
Females with type 2 diabetes have a significantly higher relative risk of developing macro- and microvascular comorbidities compared to males, highlighting the need for sex-specific management strategies.
May support sex-specific screening in type 2 diabetes; leaves open whether targeted interventions improve outcomes.
Introduction and Objective: Sex differences in macrovascular complications of type 2 diabetes (T2D) are known, but evidence on microvascular differences remain limited. Methods: We used an Austrian medical claims database of 8.9 million individuals (1997-2014). Comorbidities co-occurring with T2D were analyzed using sex- and age-specific contingency tables across 2-year intervals (2003-2014), with odds ratios estimated via the Cochran-Mantel-Haenszel method. Only comorbidities with sufficient case numbers were retained. Sex differences were quantified by the differences of logarithmic ORs between male and females in units of pooled standard errors assessed using a Bonferroni-corrected test. Results: In 40 to 49 year olds, females had more retinopathy (OR 9.3 vs. 5.5), chronic kidney failure (CKI: OR 9.8 vs. 6.5), depression (OR 3.1 vs. 1.9) and cardiovascular complications including chronic ischemic heart disease (CIHD: OR 10.8 vs. 5.6), heart failure (HF: OR 12.1 vs. 7.7) and acute myocardial infarction (MI: OR 9.4 vs. 3.9, all p-values <0.001) compared to males with T2D. In 50 to 59 year olds, females had higher rates of CKI (OR 9.2 vs. 6.2), depression (OR 2.8 vs. 1.9) and cardiovascular complications (CIHD: OR 6.8 vs. 4.4, HF: OR 8.7 vs. 5.3, MI: OR 5.7 vs. 2.7) compared to males. Retinopathy showed no sex differences, but cerebral infarction was more frequent in females (OR 4.4 vs. 3.2). In age group 60 to 69 year olds, females had higher rates in cardiovascular complications (CIHD: OR 4.8 vs. 3.7, HF: OR 6.4 vs. 4.3, MI: OR 3.8 vs. 2.5), retinopathy (OR: 2.5 vs. 3.0), CKI (OR 7.3 vs. 4.9) and depression (OR: 2.5 vs. 2.0). Lastly, in 70 to 79 year olds the least differences with a higher rate of cardiovascular complications (CIHD: OR 3.5 vs. 3.2, MI: OR 3.1 vs. 2.3) and CKI (OR 5.0 vs. 4.0, all p-values<0.001) in females compared to males was reported. Conclusion: More comorbidities were associated with T2D in females than in males, including cardiovascular disease, retinopathy, nephropathy, and neuropathy. These results support more personalized and effective management strategies. Disclosure T. Gisinger: None. K. Fenz: None. P. Klimek: None. E. Dervic: None. A. Kautzky-Willer: None.
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GISINGER et al. (2026) conducted an observational in Type 2 Diabetes (n=8,900,000). Female sex vs. Male sex was evaluated on Comorbidities co-occurring with T2D (p=<0.001). Females with type 2 diabetes had significantly higher odds of cardiovascular disease, retinopathy, nephropathy, and depression compared to males across multiple age groups (all p<0.001).
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