Women, Men With Type 2 Diabetes Face Different Paths to Complications

Women who develop type 2 diabetes (T2D) are more likely than men to develop a mental health condition, and men are more likely to develop cardiovascular disease or kidney failure, according to a study published in PLOS Medicine.¹

The observational cohort study, led by Fabiola Eto, from the Wolfson Institute of Population Health at Queen Mary University of London (QMUL) in London, United Kingdom, used multistate analysis to track the order and timing of complications in 28,720 individuals with incident T2D, drawing on data from the UK Clinical Practice Research Datalink GOLD.¹

Over a median follow-up of 6.8 years, 39% of the cohort (11,161 individuals) experienced at least 1 significant health event after their T2D diagnosis. The cohort was 62% men, with a median age of 54 years at T2D onset. Women were typically diagnosed later at a median age of 56.1

Divergent Trajectories by Sex

The study identified 11 possible health states and 19 distinct trajectory patterns following T2D onset, using diagnoses of hypertension, anxiety/depression/somatoform disorder, and cardiovascular disease (CVD) or end-stage renal disease (ESRD) recorded in primary and secondary care records.¹

Women of any age were more likely than men to be diagnosed with a mental health condition after T2D onset, with women aged 16 to 39 years showing the highest probability of any group. Men, by contrast, had a higher probability of a CVD or ESRD diagnosis than women in every age group, and that probability increased as men aged.¹

Timing also diverged between the sexes. Women generally had a later onset of complications than men, and hypertension was the most frequent event following T2D onset across nearly all age groups and both sexes, the exception being the youngest women.¹

Mental health conditions emerged at the earliest age for both sexes, developing at a median age of 50 in women and 51 in men. Men reached their earliest median age for a CVD or ESRD diagnosis sooner than women, at 60 years old versus 66 years old. Women also used more health services overall, with higher average consultations and long-term prescribing than men across nearly all trajectories.¹

Mortality and the Combined-Risk Group

Both sexes experienced earlier mortality when T2D was combined with a mental health condition, compared with other trajectories. Among patients who developed a mental health condition followed by death, men died at an average age of 61, about 9 years younger than women following the same T2D-to-mental-health-to-death sequence, who died at an average age of 70. That gap held despite women in this group having higher average long-term prescribing, primary care consultations, and hospitalizations over a 10-year period than men.¹

"One of the clearest signals in our data was the sex difference. Younger women with type 2 diabetes were showing mental health complications earlier and more often than we expected, which suggests routine psychological screening should be incorporated into standard diabetes care," Fabiola Eto, of the Wolfson Institute of Population Health at QMUL, said in a news release.² "For men, cardiovascular and kidney risks tended to emerge earlier, pointing to a need for earlier monitoring and stronger strategies to support men's engagement with their treatment over time."

The study authors noted that current UK medical guidelines lack sex-specific prevention and management strategies for T2D and its comorbidities, particularly mental health conditions. As a limitation, they cautioned that their descriptive design cannot establish causation and that some of the observed sex differences in mental health diagnoses may reflect differences in health care seeking behavior rather than true differences in the underlying prevalence of these conditions.¹

What It Means for Pharmacists

The authors called for routine mental health screening to be built into T2D care pathways, alongside earlier cardiovascular and kidney disease monitoring and stronger healthcare engagement strategies for men.¹

Pharmacists are well positioned to support both. A 2025 perspective in the Journal of Clinical Medicine described a role for pharmacists in conducting brief mental health screenings to identify diabetes and prediabetes patients at greater risk of a mental health disorder, then referring those who screen positive to mental health professionals, therapists, community resources, or support groups. The article also noted that the American Diabetes Association recommends routine psychosocial screening for depression, anxiety, diabetes distress, and disordered eating at the time of diagnosis and periodically thereafter.³

On the cardiorenal side, that same article outlined a pharmacist role in optimizing glucose-lowering therapy for patients with comorbidities, including prioritizing glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with existing cardiovascular disease, obesity, or chronic kidney disease, and adjusting regimens through collaborative practice agreements with providers.³

A separate 2023 review in Diabetologia noted that although men with type 2 diabetes have a higher absolute risk of cardiovascular mortality, the relative risk is significantly greater in women with the disease and that women with type 2 diabetes are prescribed statins, aspirin, and beta blockers less often than men in cardiovascular outcome trials.⁴

The review also cited a Danish cohort study finding that cardioprotective glucose-lowering drugs, including SGLT2 inhibitors and GLP-1 receptor agonists, were prescribed less often to women with type 2 diabetes and cardiovascular disease than to men.⁴ Pharmacists reviewing medication regimens may be positioned to flag such gaps regardless of a patient's sex.

REFERENCES

1. Eto F, Samuel M, Stow D, et al. Sex differences in trajectories to cardio-renal and mental health outcomes following the onset of type 2 diabetes: An observational cohort study using multi-state analysis in the UK Clinical Practice Research Datalink. PLoS Med. 2026;23(8):e1005196. Published 2026 Aug 25. doi:10.1371/journal.pmed.1005196

2. Women with type 2 diabetes are more likely than men to develop mental health conditions. News release. PLOS. August 25, 2026. Accessed August 26, 2026. https://www.eurekalert.org/news-releases/1140245

3. Uddin S, Sanchez Machado M, Alshahrouri B, et al. Empowering Pharmacists in Type 2 Diabetes Care: Opportunities for Prevention, Counseling, and Therapeutic Optimization. J Clin Med. 2025;14(11):3822. Published 2025 May 29. doi:10.3390/jcm14113822

4. Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia. 2023;66(6):986-1002. doi:10.1007/s00125-023-05891-x