In the years following type 2 diabetes diagnosis, women are more likely to develop mental health conditions, while men are more likely to develop cardiovascular and renal complications, according to a study published August 25th in the open access journal PLOS Medicine by Fabiola Eto from Queen Mary University of London, UK, and colleagues.
Type 2 diabetes, a metabolic disorder defined by high blood sugar, results from resistance to or insufficient production of insulin. Globally, type 2 diabetes affects about 536.6 million people between 20 and 79 years old, or 10.5% of the population; by 2045, this number is expected to rise to 700 million. Cardiovascular disease, end-stage renal disease, and mental health disorders like depression and anxiety are all associated with type 2 diabetes. Women and men are known to experience these conditions differently, but research has not yet described the disease trajectories according to sex and age in people with type 2 diabetes.
Eto and colleagues examined anonymized health records from 28,720 men and women in the UK who developed type 2 diabetes between 2010 and 2020. Men constituted 62% of the cohort with a median age of 54 at type 2 diabetes onset; women were on average older at diagnosis.
In the years following diagnosis, 39% of the participants experienced at least one significant health event. The events' trajectory and timing differed by sex. For example: women were more likely to develop mental health conditions post-diagnosis (8.1% compared to 5.3%) and to experience trajectories culminating in death, while men showed higher proportions of cardiovascular disease (8.4% compared to 5.3%), end-stage renal disease, and hypertension (21.1% compared to 20.2%). The researchers noted that on average, women used more health services and long-term prescriptions than men, which may contribute to the increased diagnoses.
There were several similarities between the sexes as well. Both women and men who had a combination of type 2 diabetes and a mental health condition experienced premature mortality compared to other trajectories. Across all age groups and sexes, hypertension was the most frequent event following type 2 diabetes.
Current UK medical guidelines lack sex-specific prevention strategies and management for type 2 diabetes and comorbidities, especially mental health conditions. This study highlights the need for healthcare interventions differentiated by characteristics like sex and age.
The authors add, "One of the clearest signals in our data was the sex difference. Younger women with type 2 diabetes were showing mental health complications earlier and more often than we expected, which suggests routine psychological screening should be incorporated into standard diabetes care. For men, the pattern looked different: cardiovascular and kidney risks tended to emerge earlier, pointing to a need for earlier monitoring and stronger strategies to support men's engagement with their treatment over time."
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/3TxEaIz
Citation: Eto F, Samuel M, Stow D, Henkin R, Angdembe A, Barnes MR, et al. (2026) Sex differences in trajectories to cardio-renal and mental health outcomes following the onset of type 2 diabetes: An observational cohort study using multi-state analysis in the UK Clinical Practice Research Datalink. PLoS Med 23(8): e1005196. https://doi.org/10.1371/journal.pmed.1005196
Author countries: United Kingdom
Funding: This work (and salary costs to SF, RM, and FE) was supported by MRC (MR/S027297/1). "Multimorbidity clusters, trajectories and genetic risk in British south Asians, 2020-2023". Link: https://gtr.ukri.org/projects?ref=MR%2FS027297%2F1 . Additional support for this and related work (SF, MRB, RH, AA, MS, DS, and FE) is from NIHR 31672 AI-MULTIPLY, 2022-2025, and NIHR 202635 (SF, MRB). MRB is also funded by NIHR Newcastle Patient Safety Research Collaborative (NIHR204291). RM is also supported by Barts Charity (MGU0504). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
