More men get diabetes than women – and the difference is influenced by a woman’s body shape.
Many women store fat around their hips and thighs, giving them a curvier shape than men, who tend to store fat around their organs, which can be more harmful to the metabolism.
Speaking before World Diabetes Day (November 14), Dr Henrik Premasundaram, a GP at HCA Healthcare UK, points out that type 2 diabetes accounts for around 90% of diabetes cases and says: “Although diabetes affects both men and women, men are more likely to be diagnosed with type 2 diabetes, often at a younger age and at a lower BMI than many people expect.
“One important reason men are at higher risk is body fat distribution – men tend to accumulate more visceral fat around their internal organs, whereas premenopausal women more often store fat around their hips and thighs. Visceral fat is particularly associated with insulin resistance, which is a key driver of type 2 diabetes.”
And Esther Walden, a senior clinical advisor at Diabetes UK, explains that while men’s visceral fat can build up around organs like the liver and pancreas, thus leading to the strong link associated with insulin resistance (the pancreas produces insulin, and the liver receives the insulin to store and manage blood sugar), “Premenopausal women tend to store more fat subcutaneously (under the skin), particularly in the hips and thighs, which is less harmful metabolically.”
And as well as the typical differences in the body shape of men and women, research has shown that genetic variations have a bearing on where excess fat is stored, and thus on diabetes risk. Researchers from King’s College London, part-funded by the British Heart Foundation, discovered that in women, versions of a gene that results in fat being stored around the hips rather than the abdomen are linked to a lower risk of diabetes.
Men can develop diabetes at a lower BMI
Diabetes UK estimates that one in five (over 12 million) UK adults are living with or at risk of diabetes – around 4.6 million people have a diagnosis of diabetes, and an additional 1.3 million are thought to be living with type 2 diabetes but are undiagnosed. More than 350,000 have type 1 diabetes.
The key warning signs of type 1 diabetes, says Walden, are excessive thirst, unusual tiredness, unexplained weight loss, and going to the toilet more frequently, known as the 4Ts: thirsty, tired, thinner and toilet.
Symptoms of type 2 diabetes can be similar to those of type 1, including the 4Ts, although Walden stresses: “Because type 2 diabetes typically develops more gradually, these symptoms may be much less obvious.”
Type 2, which occurs when the body doesn’t make enough insulin, or the insulin it does produce doesn’t work properly, is often associated with people who are overweight. However, because some of men’s fat is stored around their organs and is less obvious than women’s fat on their hips and thighs, they may not carry as much weight as a woman to be more at risk of developing the condition.
Premasundaram explains: “Men can develop type 2 diabetes at a lower BMI than women, meaning they don’t necessarily need to be significantly overweight to be at risk.
“From a GP perspective, the key message is that type 2 diabetes can develop without obvious symptoms. Men should not assume they’re at low risk simply because they’re physically active or have a relatively normal body weight.”
He says regular health assessments are particularly worthwhile for people with a family history of diabetes, increased abdominal fat, high blood pressure or other metabolic risk factors. “A blood test can identify raised blood glucose levels before symptoms develop, allowing earlier intervention,” he points out.
Hormonal differences
Walden says differences in sex hormones are also linked to the reason why men are more likely to get diabetes than women.
“Oestrogen has protective effects on insulin sensitivity, fat distribution and glucose metabolism,” she explains. “This generally means women have lower fasting glucose levels and better beta cell preservation [pancreatic beta cells produce and release insulin to regulate blood sugar, and when they are damaged, destroyed, or overworked, the body loses its ability to control glucose properly].
“After menopause the reduction in oestrogen is associated with increased visceral fat and therefore increased risk of type 2 diabetes.”
Differences in glucose metabolism
Type 2 diabetes can be diagnosed using a fasting glucose test (a blood test done after a period of fasting) – but this is less likely to pick up diabetes in women than it is in men.
Walden explains: “We know men are more likely to develop higher fasting glucose levels, whereas women are more likely to develop higher glucose levels after meals. This means that a fasting glucose test alone is less likely to detect changes to glucose metabolism in women.”
Men are slightly more likely to get type 1 diabetes too
Premasundaram explains that type 1 diabetes is different to type 2 as it’s an autoimmune condition in which the immune system attacks the insulin-producing cells of the pancreas.
“Unlike type 2 diabetes,” he says, “it’s not caused by lifestyle or excess body weight. There’s a modest male predominance in some populations, particularly those of European ancestry, although this varies geographically and the reasons aren’t fully understood. Genetic, hormonal and immune-system differences may all play a role.
Walden says some studies have shown slightly more boys than girls develop type 1 diabetes, particularly after puberty, but this difference isn’t as big or consistent as those seen in type 2 diabetes.
“The patterns in type 1 diabetes are less clear and reasons for these small differences aren’t fully understood,” she says.
Men are more at risk of side-effects
A 2024 University of Sydney study suggests men are at greater risk than women of the major health effects of both type 1 and type 2 diabetes.
The study found rates of cardiovascular disease, leg, foot, and kidney complications, and the sight-threatening eye disease diabetic retinopathy are all higher in men, regardless of whether they had diabetes for more or less than 10 years.
Premasundaram adds: “The encouraging news is that type 2 diabetes can often be prevented or delayed through sustainable lifestyle changes, including regular physical activity, maintaining a healthy weight, improving dietary quality and reducing abdominal fat. Even relatively modest changes can make a meaningful difference to long-term metabolic health.
“Ultimately, this isn’t about suggesting diabetes is exclusively a male problem. It’s about recognising that men and women can have different risk profiles and ensuring that those at risk are identified early.”
Find out your individual risk of developing type 2 diabetes and steps you can take to reduce it by using Diabetes UK’s free online Know Your Risk tool.
