Diabetes is often discussed as though it behaves identically in every patient, with the same warning signs, the same risks and the same treatment targets regardless of who sits across the consultation desk. Diabetologists increasingly disagree with this one-size-fits-all view, pointing to a growing body of clinical evidence that men and women often experience diabetes, and respond to its treatment, in meaningfully different ways.
Different bodies, different risk patterns
Hormonal differences play a significant role in how diabetes develops and progresses. In women, conditions such as polycystic ovary syndrome and gestational diabetes create risk pathways that simply do not exist for men, while the hormonal shifts of menopause can further complicate blood sugar control in later life. Men, meanwhile, tend to accumulate visceral fat, the metabolically active fat around abdominal organs, at lower body weights than women, which can trigger insulin resistance earlier and with fewer obvious outward signs. Diabetologists note that this difference alone means the same BMI reading can carry quite different risk implications depending on the patient's sex.
The cardiovascular gap nobody talks about
Perhaps the most striking distinction lies in cardiovascular risk. Diabetes appears to erode the natural cardiovascular protection that women typically have before menopause, meaning diabetic women often face a proportionally higher increase in heart disease risk compared with diabetic men. Despite this, women are frequently under-diagnosed and under-treated for heart-related complications of diabetes, partly because symptoms of cardiac trouble can present differently in women and are sometimes dismissed or attributed to other causes.
Debunking the "same symptoms, same disease" myth
A common misconception is that diabetes announces itself the same way in everyone, through thirst, fatigue and frequent urination. In practice, women may experience recurrent urinary or vaginal infections as an early sign, while men may notice symptoms related to reduced testosterone or sexual health before classic diabetic symptoms even appear. Treating these as unrelated issues, rather than potential markers of underlying diabetes, can delay diagnosis considerably.
Why treatment response also differs
Beyond diagnosis, diabetologists observe that medication response and side-effect profiles are not always identical across sexes, and psychological or lifestyle factors, such as differing stress patterns, caregiving responsibilities and body image concerns, can influence adherence to treatment plans in distinct ways. Blanket dosing and generic lifestyle advice, without accounting for these differences, may leave gaps in effective long-term management.
Towards personalised diabetes care
None of this suggests men and women require entirely separate diabetes textbooks, but it does support a more individualised approach to screening, symptom recognition and treatment planning. Diabetologists increasingly advocate for clinicians to factor in sex-specific risk markers, particularly around cardiovascular health and hormonal life stages, rather than applying uniform thresholds and treatment protocols across the board.
A more accurate picture of the disease
Recognising that diabetes does not manifest, progress or respond to treatment identically in men and women is not a matter of complicating care unnecessarily; it is a matter of making that care more precise. As diabetologists continue to push for gender-aware clinical guidelines, patients stand to benefit from diagnoses that arrive sooner and treatment plans that fit their bodies more closely.
The author is the Director - Diabetes, Obesity & Metabolic Clinic, CK Birla Hospital, Gurgaon.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
