Sex differences in glycemic outcomes: a systematic review and meta-analysis of diabetes treatments
Authors' conclusion
Sex-related differences in glycemic outcomes under insulin therapy were observed, with patterns varying by diabetes type, treatment context, and outcome. Given the low certainty and heterogeneity of the evidence, these findings should be interpreted as hypothesis-generating rather than directive for clinical practice. The results support consideration of biological sex as one component within a broader, individualized diabetes management framework. Future studies should prioritize sex-stratified analyses with rigorous control of polypharmacy, body composition, and lifestyle factors to determine whether sex-specific insulin strategies provide meaningful clinical benefit.
Study context
- Population
- Adults of both sexes on insulin reporting sex-specific data; T1D and T2D; studies Aug 2014–Dec 202524 studies
- Comparison
- Women vs men on insulin therapy
- Outcome
- T1D: achieving HbA1c <7%
Methodological detailsGRADE certainty assessment
- GRADE certainty assessment
Pooled result
As reported in the abstract
Relative risk
1.05
95% CI 0.91–1.22
Further pooled results
| Outcome | SMD (CI) | |
|---|---|---|
| T1D: TIRToward higher with women; moderate certainty | 0.78 (−0.01 to 1.57) | |
| T2D: weight-adjusted insulin doseVery low certainty | 0.55 (0.23–0.86) | |
| −1012Difference (linear scale) |
| Outcome | RR (95% CI) | |
|---|---|---|
| T2D: achieving HbA1c targetsMen more likely; low certainty | 0.86 (0.72–1.03) | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Hypoglycemia riskOpposing trends inpatientvs outpatientBetween Women and Men · inpatient; very low certainty | 0.78 (0.33–1.83) | |
| Hypoglycemia riskOpposing trends inpatientvs outpatientBetween Women and Men · outpatient; low certainty | 1.08 (0.61–1.89) | |
| 0.20.5125Relative risk (log scale) |
- Hypoglycemia risk — Substantial heterogeneity (I2)
- >70%
Original publication
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