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. 2023 Dec 13;14(1):88.
doi: 10.1186/s13293-023-00571-2.

Sex differences in type 2 diabetes: an opportunity for personalized medicine

Meredith L Johnson #  1 , Joshua D Preston #  2   3 , Cetewayo S Rashid  4 , Kevin J Pearson  4 , J Nina Ham  5
Affiliations

Sex differences in type 2 diabetes: an opportunity for personalized medicine

Meredith L Johnson et al. Biol Sex Differ. .

Abstract

Over the past several decades, substantial ground has been gained in understanding the biology of sex differences. With new mandates to include sex as a biological variable in NIH-funded research, greater knowledge is forthcoming on how sex chromosomes, sex hormones, and social and societal differences between sexes can affect the pathophysiology of health and disease. A detailed picture of how biological sex impacts disease pathophysiology will directly inform clinicians in their treatment approaches and challenge canonical therapeutic strategies. Thus, a profound opportunity to explore sex as a variable in personalized medicine now presents itself. While many sex differences are apparent in humans and have been described at length, we are only beginning to see how such differences impact disease progression, treatment efficacy, and outcomes in obesity, type 2 diabetes, and cardiovascular disease. Here, we briefly present the most salient and convincing evidence of sex differences in type 2 diabetes detection, diagnostics, disease course, and therapeutics. We then offer commentary on how this evidence can inform clinicians on how to approach the clinical workup and management of different patients with diabetes. Finally, we discuss some gaps that remain in the literature and propose several research questions to guide basic and translational researchers as they continue in this growing area of scientific exploration.

Keywords: Chronic complications; Detection; Diagnosis; Obesity; Sex difference; Sexual dimorphism; Therapy; Type 2 diabetes.

Plain language summary

For decades, most research in the laboratory and clinical settings focused primarily on males. However, more recently, grant-funding agencies, including the National Institutes of Health, have prioritized research that studies both males and females. This has dramatically improved our understanding of how biological sex impacts whether a person is at higher risk for developing a particular disease and what treatment options may be best to achieve the healthiest outcomes. This article offers the perspectives of practicing physicians and scientists on how our knowledge about biological sex may impact disease incidence, progression, treatment options, and outcomes in obesity, diabetes, and heart disease. The piece will offer a broad overview of the current science and personalized medicine approaches in these areas. It then discusses gaps in our knowledge and proposes several questions to guide future research.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Graphical summary of sex differences in diabetes care and research. Abbreviations: AT adipose tissue, F female, FPG fasting plasma glucose, GDM gestational diabetes mellitus, GLP-1 RA glucagon-like peptide-1 receptor agonist, IR insulin resistance, MHRT menopausal hormone replacement therapy, OGTT oral glucose tolerance test, PCOS polycystic ovarian syndrome, M male, SGLT2i sodium–glucose cotransporter-2 inhibitor, SU sulfonylurea, T testosterone, T2D type 2 diabetes, TZD thiazolidinedione
See this image and copyright information in PMC

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