Women with T2D are more likely to discontinue metformin and less likely to be prescribed SGLT2 inhibitors despite similar cardiovascular benefits compared to men.
Are there sex-specific differences in the prescribing patterns, efficacy, and tolerability of non-insulin antihyperglycemic agents in patients with type 2 diabetes?
While glucose-lowering therapies offer comparable cardiovascular protection in men and women, significant sex differences in prescribing patterns and tolerability exist, highlighting the need for balanced trial representation.
Women with type 2 diabetes (T2D) experience disproportionately greater cardiovascular risk than men, yet sex-specific differences in the use and effects of glucose-lowering therapies remain underexplored. This narrative review summarizes evidence on prescribing patterns, efficacy, and tolerability of non-insulin antihyperglycemic agents in women versus men. Across most drug classes, glycemic and cardiovascular efficacy appear broadly comparable, though differences in tolerability and prescribing are evident: women more often discontinue metformin, are less frequently prescribed SGLT2 inhibitors despite equal cardio-renal benefit, and are more likely to receive GLP-1 receptor agonists. Sex variations include greater TZD efficacy in obese women, stronger sulfonylurea response in non-obese men, and modestly greater weight loss in women treated with incretin-based therapies. Addressing prescribing disparities and ensuring balanced trial representation remain critical priorities. • Women are more likely than men to discontinue metformin from GI side effects • Women are more likely than men to be prescribed GLP-1 RA and less likely SGLT2i • Most drug classes achieve similar HbA1c reduction and cardiovascular protection between sexes • Impact of sex differences in prescribing on cardiovascular outcomes remains unknown • Balanced trial representation and sex-specific analyses are essential to optimize diabetes care and cardiovascular outcomes
Gupta et al. (2026) studied this question. Women with T2D are more likely to discontinue metformin and less likely to be prescribed SGLT2 inhibitors despite similar cardiovascular benefits compared to men.