Influence of Gender in Diabetes Mellitus and Its Complication

Abstract

In medicine, there is growing evidence that gender differences are important and lead to variations in the pathophysiology and treatment of many diseases with traits that appear to be particularly relevant in influencing the outcomes of many morbid forms. Today, the inclusion of gender in biomedical research, to improve the scientific quality and scientific relevance of knowledge, of technology is an increasingly present element precisely due to the practical implications that derive from it. Gender differences describe the biological variability between women and men, which is, in turn, related to differences in the information contained in sex chromosomes, the specific gene expression of autosomes linked to sex, the different number and quality of sex hormones, and their different effects on systems and organs, without neglecting the fact that each of the sexes has different target organs on which these hormones act. Additionally, both genders undergo metabolic changes throughout their lives, and this is especially true for women who show more dramatic changes due to their role in reproduction. Gender differences are not only the result of our genetic makeup but are also mixed with socio-cultural habits, behaviors, and lifestyles, differences between women and men, exposure to specific environmental influences, different food and lifestyle styles or stress, or different attitude in compliance with treatments and disease prevention campaigns. Gender differences also affect behavior throughout life, and physical changes can have implications for lifestyle, social roles, and mental health. Therefore, determinism and therapeutic outcome in chronic diseases are influenced by a complex combination of biological and environmental factors, not forgetting that there are many interactions of social and biological factors in women and men. This review will address the role of gender differences in the management of various forms of diabetes and its complications considering the different biological functions of hormones, the difference in body composition, physiological differences in glucose and fat metabolism, also considering the role of the microbiota. intestinal, as well as the description of gestational diabetes linked to possible pathophysiological events typical of reproduction.

Addressing the Continuum of Dysglycaemia and Vascular Complications in Prediabetes and Type 2 Diabetes: Need for Early and Intensive Treatment

“…10,11 Interestingly, there is evidence that men tend to present with prediabetes driven by elevation of fasting glucose (impaired fasting glucose; IFG), driven by increased hepatic glucose output and blunted first-phase insulin secretion, while women tend to present with elevation of post-load glucose (impaired glucose tolerance; IGT), driven by insulin resistance in the periphery. 12 Systematic reviews have associated changes in the gut microbiome with insulin resistance, prediabetes and type 2 diabetes, with some evaluations of probiotics demonstrating improvements in glycaemic control. [13][14][15] These associations are variable, however, and this approach remains in the arena of research.…”

Impact of Comorbidity of Bronchial Asthma and Type 2 Diabetes Mellitus on the Expression and Functional Activity of TLR2 and TLR4 Receptors

“…The first limitation is a small number of patients in the study groups. Furthermore, due to the small sample size, we do not consider and do not discuss the role of sex in the formation and progression of the studied diseases, although there are numerous studies confirming the effect of sex and gender on the progression of T2DM or asthma [ 13 , 14 ]. Finally, a clear definition of the role of the studied receptors in the formation of BA, T2DM, and their comorbidity requires knockout and/or blockage of TLR2 and TLR4 via siRNA or specific antibodies, and an extension of the experimental groups as well.…”

“…The main causes of sex-related differences are the changes in sex hormone concentrations that could lead to the effect of age-dependent transitions, such as puberty in men and women, and the menstrual cycle, pregnancy, and menopause in women, on asthma and diabetes. Sex differences could also be related to genetic, cellular, or physiological aspects, but the studies in these directions are in progress [ 13 , 14 ].…”

Overall Clinical Features of Type 2 Diabetes Mellitus With Respect to Gender

“…According to the stage of reproductive life, the gender disparity in diabetes incidence is changed: more men develop diabetes before puberty, whereas more women develop diabetes after menopause and in later life. Considering the higher incidence of type 2 diabetes in women, it is critical to emphasize that males are more likely to develop forms of diabetes exacerbated by diabetic ketoacidosis or ketosis [ 8 ]. Women are protected from ketosis and ketoacidosis, and only a hypoestrogenic or protracted ovulatory state renders this protection ineffective [ 8 ].…”

“…Considering the higher incidence of type 2 diabetes in women, it is critical to emphasize that males are more likely to develop forms of diabetes exacerbated by diabetic ketoacidosis or ketosis [ 8 ]. Women are protected from ketosis and ketoacidosis, and only a hypoestrogenic or protracted ovulatory state renders this protection ineffective [ 8 ].…”