A meta-analysis of 24 studies found that sex-related differences in glycemic outcomes under insulin therapy vary by diabetes type and treatment context, with women requiring higher weight-adjusted insulin doses in type 2 diabetes and men more likely to achieve HbA1c targets.
- In type 2 diabetes, women required higher weight-adjusted insulin doses than men, while men were more likely to achieve HbA1c targets
- In type 1 diabetes, women showed no significant difference in achieving HbA1c <7% and trended toward higher time-in-range
- Evidence certainty was low to very low, with substantial heterogeneity across studies
How this compares to prior research
Sex differences in glycemic outcomes following insulin therapy have been underexplored despite biological and psychosocial factors that may influence individual responses. Previous research has not systematically examined how sex affects glycemic control across different diabetes types and treatment contexts. This gap has limited the ability to provide personalized diabetes care and promote health equity based on sex-specific treatment responses.
Diabetes prevalence globally, 1980–1989
Key findings
- Women with type 2 diabetes required higher weight-adjusted insulin doses (SMD 0.55, 95% CI 0.23 to 0.86) compared to men
- Men with type 2 diabetes were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03)
- Hypoglycemia risk showed opposing trends in inpatient versus outpatient settings with substantial heterogeneity (I2 >70%)
What this means in practice
- Discuss with your doctor whether your sex might influence your insulin dose requirements, especially if you have type 2 diabetes
- Consider that glycemic control targets may be achieved differently based on biological sex and treatment setting
- Recognize that current evidence is preliminary and individualized care should account for multiple factors beyond sex alone
Frequently asked questions
Do women and men respond differently to insulin therapy?
Yes, patterns vary by diabetes type. In type 2 diabetes, women require higher insulin doses while men achieve HbA1c targets more often. However, evidence certainty is low.
What is the difference in glycemic control between sexes in type 1 diabetes?
Women showed no significant difference in achieving HbA1c <7% and trended toward higher time-in-range, though evidence certainty was very low to moderate.
Should insulin dosing be adjusted based on sex?
Current evidence is hypothesis-generating only. Sex should be considered as one component within individualized diabetes management, but more rigorous studies are needed.
Key terms explained
HbA1c
Glycated hemoglobin, a measure of average blood sugar levels over the past 2-3 months, with <7% often used as a target
Time-in-range
The percentage of time blood glucose levels stay within a target range, typically 70-180 mg/dL
Weight-adjusted insulin dose
The amount of insulin prescribed relative to body weight, measured in units per kilogram
Source: Sex differences in glycemic outcomes: a systematic review and meta-analysis of diabetes treatments. · DOI: pii: e005808. doi: 10.1136/bmjdrc-2025-005808