One Size Does Not Fit All: The Need for Sex-Specific Precision Medicine in Diabetes Technology

Stefanie Hossmann¹, Susanne Tan^{2

3}, Julia K Mader⁴, David C Klonoff⁵, Dawn Adams⁶, Hanne Ballhausen¹, Lia Bally⁷, Maria L Balmer^{1

8}, Vincent Braunack-Mayer¹, Anne Bonhoure^{9

10}, David Burren^{11

12

13}, Charlotte K Boughton¹⁴, Deniz Cengiz¹⁵, Claudia Eberle^{16

17}, Chiara Fabris¹⁸, Maya Friedman¹⁹, Elke Fröhlich-Reiterer²⁰, Tim Gunn^{11

12}, Olga Gusyatiner²¹, Theresa Hastings¹⁵, Valentina V Huwiler^{1

8}, Saira Khan-Gallo¹⁹, Carol J Levy²², Othmar Moser^{4

23

24}, Aisling Ann O'Kane²⁵, Cameron Keighron²⁶, Nick Oliver²⁷, Temiloluwa Prioleau²⁸, Tanja Thybo²⁹, Jane Yardley^{9

30}, Thomas Zueger^{7

31}, Gabriele Faber-Heinemann³², Lutz Heinemann³², Martina Rothenbühler¹

Affiliations

¹ Diabetes Center Berne, Bern, Switzerland.
² Department of Diabetes and Endocrinology, Heart and Diabetes Center NRW, Ruhr University Hospital Bochum, Bad Oeynhausen, Germany.
³ University Bielefeld, Bielefeld, Germany.
⁴ Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
⁵ Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.
⁶ Southern Health and Social Care Trust, Southern College of Nursing, Craigavon Area Hospital, Portadown, Ireland.
⁷ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Bern, Switzerland.
⁸ Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
⁹ Montreal Clinical Research Institute, Montreal, QC, Canada.
¹⁰ Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
¹¹ Nascence BioMed, Melbourne, VIC, Australia.
¹² Nascence BioMed, Hamilton, New Zealand.
¹³ Baker Heart & Diabetes Institute, Melbourne, VIC, Australia.
¹⁴ Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
¹⁵ Diabetes Community, Regensburg, Germany.
¹⁶ Internal Medicine and General Medicine, Fulda University of Applied Sciences, Fulda, Germany.
¹⁷ Public Health Center Fulda, Fulda University of Applied Sciences, Fulda, Germany.
¹⁸ Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
¹⁹ Tidepool, Palo Alto, CA, USA.
²⁰ Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
²¹ Ypsomed AG, Burgdorf, Switzerland.
²² Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²³ Department of Exercise Physiology and Metabolism (Sportsmedicine), University of Bayreuth, Bayreuth, Germany.
²⁴ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
²⁵ School of Computer Science, University of Bristol, Bristol, UK.
²⁶ University of Galway, Galway, Ireland.
²⁷ Department of Metabolism, Diabetes and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
²⁸ Computer Science, Dartmouth College, Hanover, NH, USA.
²⁹ Danish Diabetes Association, Glostrup, Denmark.
³⁰ School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
³¹ Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland.
³² Science Consulting in Diabetes GmbH, Düsseldorf, Germany.

PMID: 40413613
PMCID: PMC12104206
DOI: 10.1177/19322968251340673

One Size Does Not Fit All: The Need for Sex-Specific Precision Medicine in Diabetes Technology

Stefanie Hossmann et al. J Diabetes Sci Technol. 2025.

. 2025 May 25:19322968251340673.

doi: 10.1177/19322968251340673. Online ahead of print.

Authors

Affiliations

¹ Diabetes Center Berne, Bern, Switzerland.
² Department of Diabetes and Endocrinology, Heart and Diabetes Center NRW, Ruhr University Hospital Bochum, Bad Oeynhausen, Germany.
³ University Bielefeld, Bielefeld, Germany.
⁴ Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
⁵ Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.
⁶ Southern Health and Social Care Trust, Southern College of Nursing, Craigavon Area Hospital, Portadown, Ireland.
⁷ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Bern, Switzerland.
⁸ Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
⁹ Montreal Clinical Research Institute, Montreal, QC, Canada.
¹⁰ Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
¹¹ Nascence BioMed, Melbourne, VIC, Australia.
¹² Nascence BioMed, Hamilton, New Zealand.
¹³ Baker Heart & Diabetes Institute, Melbourne, VIC, Australia.
¹⁴ Wellcome-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
¹⁵ Diabetes Community, Regensburg, Germany.
¹⁶ Internal Medicine and General Medicine, Fulda University of Applied Sciences, Fulda, Germany.
¹⁷ Public Health Center Fulda, Fulda University of Applied Sciences, Fulda, Germany.
¹⁸ Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
¹⁹ Tidepool, Palo Alto, CA, USA.
²⁰ Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
²¹ Ypsomed AG, Burgdorf, Switzerland.
²² Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²³ Department of Exercise Physiology and Metabolism (Sportsmedicine), University of Bayreuth, Bayreuth, Germany.
²⁴ Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
²⁵ School of Computer Science, University of Bristol, Bristol, UK.
²⁶ University of Galway, Galway, Ireland.
²⁷ Department of Metabolism, Diabetes and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
²⁸ Computer Science, Dartmouth College, Hanover, NH, USA.
²⁹ Danish Diabetes Association, Glostrup, Denmark.
³⁰ School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
³¹ Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland.
³² Science Consulting in Diabetes GmbH, Düsseldorf, Germany.

PMID: 40413613
PMCID: PMC12104206
DOI: 10.1177/19322968251340673

Abstract

Incorporating sex-specific factors in diabetes research and treatment is essential for advancing precision medicine. There are critical gaps in understanding and applying sex-related differences. Female-specific diabetes pathophysiology manifests in three major areas: life cycle phases (including puberty, pregnancy, and menopause), lifestyle factors (such as responses to nutrition and physical activity), and insulin pharmacology. These elements significantly affect insulin sensitivity and glycemic control in women, yet are frequently underrepresented or ignored in both research and clinical practice. Greater research and clinical focus across these domains is needed to better understand and address sex-based differences in diabetes. Identifying and filling evidence gaps will support more systematic and effective care.

Keywords: AID systems; CGM; aging; diabetes management; diabetes technology; diversity; exercise; fetal programming; menopause; menstrual cycle; nutrition; puberty; reproductive health; sex diversity; sex hormones.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Sex-specific factors related to life cycle, lifestyle, and pharmacology that can affect diabetes management.

See this image and copyright information in PMC

References

1. Maiorino MI, Bellastella G, Casciano O, et al.. Gender-differences in glycemic control and diabetes related factors in young adults with type 1 diabetes: results from the METRO study. Endocrine. 2018;61(2):240-247. - PubMed
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1. Carr ALJ, Evans-Molina C, Oram RA. Precision medicine in type 1 diabetes. Diabetologia. 2022;65(11):1854-1866. - PMC - PubMed
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One Size Does Not Fit All: The Need for Sex-Specific Precision Medicine in Diabetes Technology

Affiliations

One Size Does Not Fit All: The Need for Sex-Specific Precision Medicine in Diabetes Technology

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources