Women with type 2 diabetes face higher mental health risk, men higher cardiovascular risk, UK study finds

Men and women diagnosed with type 2 diabetes go on to face markedly different health risks over the following years, according to a study published Tuesday in PLOS Medicine. Researchers at Queen Mary University of London found that women were more likely than men to develop a mental health condition after their diabetes diagnosis, while men were more likely to develop cardiovascular disease or kidney failure.

The study, led by Queen Mary's Wolfson Institute of Population Health, drew on more than a decade of linked medical records for 28,720 adults newly diagnosed with type 2 diabetes in the United Kingdom, making it one of the larger efforts to trace how the disease's downstream complications diverge by sex over time.

What the researchers found

Using primary care records, hospital data and mortality statistics from the UK Clinical Practice Research Datalink, the team tracked patients diagnosed with type 2 diabetes between 2010 and 2020 for a median of 6.8 years, watching for the onset of hypertension, cardiovascular disease, end-stage renal disease, and mental health conditions including anxiety, depression and somatoform disorder.

Overall, 39 percent of patients experienced at least one of these additional health events after their diabetes diagnosis. But the pattern of which event came first split sharply along sex lines. Women were diagnosed with a mental health condition after developing diabetes at a rate of 8.1 percent, compared with 5.3 percent of men. Men, in turn, developed cardiovascular disease or end-stage renal disease at a rate of 8.4 percent, compared with 5.3 percent of women. Hypertension was the most common complication for both sexes, affecting roughly one in five patients regardless of gender.

The divergence extended to health care use and survival, a pattern separately summarized by Medical Xpress. Women averaged 92 primary care consultations over the study period, compared with 32 for men, and were prescribed medication for longer stretches across nearly every disease pathway the researchers tracked. Yet when diabetes, a mental health condition and cardiovascular or kidney disease occurred together in the same patient, women faced substantially higher mortality risk than men with the same combination of conditions. Among patients who developed diabetes and a mental health condition, men who later died did so at a median age of 61, versus 70 for women, though the authors note the sexes had different overall risk profiles that complicate a direct comparison of that gap.

Why the difference matters

The researchers argue the findings expose a gap in how type 2 diabetes is currently managed in UK primary care, where guidelines generally do not distinguish between male and female patients when recommending screening or monitoring after diagnosis.

"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," said Fabiola Eto, the study's lead author and a researcher at Queen Mary's Wolfson Institute of Population Health.

Women in the 16-to-39 age bracket had the highest probability of a mental health diagnosis following their diabetes diagnosis of any group in the study, a pattern the authors say strengthens the case for embedding psychological screening into diabetes care specifically for younger women, rather than treating it as a general add-on. For men, the authors point instead to reinforcing early cardiovascular and kidney monitoring, given how much earlier and more often those complications appeared in male patients.

Context: an underexplored divide

Type 2 diabetes has long been known to carry different risks for men and women — women with the condition, for instance, have previously been shown in other research to face a proportionally larger jump in cardiovascular risk relative to non-diabetic women than men face relative to non-diabetic men. But most clinical guidelines and much of the research base for diabetes management were built around study populations and models that did not explicitly separate outcomes by sex over time.

What distinguishes the new analysis is its method: rather than looking at a single outcome, the Queen Mary team used a multi-state statistical model that maps the entire sequence of health events a patient passes through after diagnosis — diabetes to hypertension to cardiovascular disease, for instance, or diabetes directly to a mental health condition — across 11 possible health states and 19 possible transitions between them. That approach let the researchers see not just which conditions were more common in men or women, but in what order and at what pace they tended to unfold.

• 28,720 UK adults newly diagnosed with type 2 diabetes between 2010 and 2020 were followed for a median of 6.8 years
• 8.1 percent of women developed a mental health condition after diabetes onset, versus 5.3 percent of men
• 8.4 percent of men developed cardiovascular disease or end-stage renal disease after diabetes onset, versus 5.3 percent of women
• Women averaged 92 primary care consultations during the study period, compared with 32 for men

Who is affected

More than 4 million people in the UK live with diagnosed diabetes, the vast majority with type 2, and the disease's global prevalence has continued to rise alongside obesity rates. The study's authors say its findings are most directly relevant to primary care physicians and diabetes specialists setting screening protocols, but also to patients themselves, particularly younger women who may not currently be flagged for mental health follow-up after a diabetes diagnosis, and men who may benefit from more front-loaded cardiovascular and kidney monitoring rather than reactive treatment after complications appear.

The authors caution that their study was observational and descriptive, meaning it can identify patterns but not prove what causes them, a limitation also noted in News-Medical.net's coverage of the findings. They also note that because the data relies on health records, some of the sex difference in mental health diagnoses could reflect differences in how often men and women seek care or are asked about psychological symptoms, rather than a true difference in how often the conditions occur. The study did not include ethnicity as a variable, due to insufficient sample size for reliable subgroup analysis, and did not incorporate clinical biomarkers such as blood pressure or kidney function readings.

What happens next

The authors are calling for UK diabetes guidelines to incorporate sex-specific prevention and monitoring strategies, including routine mental health screening woven into standard diabetes care rather than left to separate referral pathways, alongside strengthened early cardiovascular and renal monitoring for men. Whether the National Institute for Health and Care Excellence or other bodies that set UK clinical guidelines take up that recommendation remains to be seen. The researchers say further work is needed to determine whether the patterns they identified in a UK population hold in other health systems and among more ethnically diverse patient groups, and to establish through prospective research whether earlier, sex-tailored screening actually improves outcomes rather than simply detecting conditions sooner.

The study was funded by the UK Medical Research Council, the National Institute for Health and Care Research, and Barts Charity. One co-author disclosed involvement with a research program partly funded by a consortium of pharmaceutical companies; the other authors declared no competing interests.