Women’s Health & Diabetes Technology – The Latest
By Julia Kenney
At ATTD 2022, researchers discussed the latest research on pregnancy, menstrual cycles, and overall health outcomes in women with diabetes. Diabetes technology can be a valuable tool to improve women’s health and empower people with real-time health data.
Women’s health was a hot topic at this year’s ATTD conference and it is clear that women, and all people with uteruses, face unique challenges in their diabetes management. As described by almost every presenter, women’s health has historically been overlooked in diabetes research and the studies presented this week provide groundbreaking insights into the experiences of women with diabetes.
Women’s health outcomes
This research is especially important because women with diabetes experience higher rates of health complications compared to men. Dr. Eda Cengiz, professor of Pediatric Endocrinology at the University of California, San Francisco, explained that women with type 2 diabetes have higher A1Cs and higher levels of glucose variability than men. This leads to increased rates of health complications in women, including heart and brain disease. Women with type 1 diabetes have higher rates of DKA and a 40% higher excess risk of premature death than men.
Some of these disparities may be attributed to the common differences between the biological sexes. Women typically have lower levels of muscle mass, energy expenditure, and visceral fat compared to men and they have higher levels of peripheral insulin sensitivity – all factors which can impact a person’s risk for diabetes complications.
Social factors, such as gender roles and discrimination, can also lead to worse health outcomes in women by limiting their access to food, healthcare, money, and social support. While a combination of these factors likely impacts women’s health, Cengiz described these as speculations and highlighted the lack of research on health disparities among men and women with diabetes.
Unfortunately, these disparities are not just physical. Women with diabetes also face high rates of mental health challenges.
“The rate of depression is extraordinarily higher in women than it is in men,” said Dr. Linda Gonder-Frederick, associate professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia.
In a study of people with type 1 diabetes, 13% of men reported having clinical depression compared to over a third of women, and 12% of men reported having clinical anxiety compared to over 20% of women.
“When women are dealing with diabetes distress, they don’t have the bandwidth to care for their diabetes in the way they might want to,” Gonder-Frederick said. This distress can lead to serious health complications.
Learn more about dealing with feelings of distress, depression, and anxiety by checking out our mental health resources.
Every woman, with or without diabetes, has a different experience with their period. The amount of bleeding, regularity, and symptoms is unique. However, all women and other people with uteruses experience the following phases of the menstrual cycle in a span of about 28 days:
Follicular phase – The period of time from the beginning of the cycle to ovulation (when the egg is released to be fertilized)
Luteal phase – The period of time from ovulation to the beginning of menstruation (when the period begins)
For women with diabetes, the menstrual cycle can actually impact their blood sugar by changing their body’s sensitivity to insulin. According to Dr. Chiara Fabris, assistant professor at the University of Virginia School of Medicine, women with type 1 diabetes can experience decreased insulin sensitivity in the luteal phase, causing highs before your period and lows during your period.
Fabris explained that with a better understanding of insulin sensitivity changes during the menstrual cycle, healthcare providers can cater your insulin dosing to specific phases of your cycle. For example, getting a slightly higher dose of insulin during your period can mitigate the risk of menstrual hypoglycemia.
Preliminary research on this approach indicates that pairing insulin dosing with menstrual phases can decrease levels of hypoglycemia and improve a person’s time in range (TIR). More research is needed on periods and insulin sensitivity before women with diabetes can receive individualized insulin dosing throughout their menstrual cycle.
Learn more by reading, “Diabetes and Periods.”
Getting pregnant, being pregnant, and recovering from a pregnancy is difficult for anyone, but it is especially challenging for women with diabetes. High levels of glucose variability can be a risk to both the mother and the baby, and women with diabetes have to work hard to avoid health complications while pregnant.
The growing body of research on women with diabetes indicates that diabetes technology such as CGMs and insulin pumps can help women and their providers manage the disease, mitigate disparities in health complications, and improve their quality of life. These technologies have proven to be especially valuable in supporting women through their pregnancies.
Professor Eleanor Scott, professor of Diabetes and Maternal Health at the University of Leeds, discussed the findings of the CONCEPTT study, which highlighted the benefits of using CGMs in type 1 diabetes pregnancies. Compared to those using a blood glucose meter (BGM), women using a CGM had lower A1Cs and spent more time in their target range. Their babies also had lower rates of health complications such as being large for their gestational age (LGA), going to intensive care, and having hypoglycemia.
In addition to helping pregnant women with diabetes manage their diabetes, Scott explains that 24-hour CGM data can also help their providers care for the mother and baby by highlighting exactly when pregnant women are experiencing highs and lows.
While the CONCEPTT study demonstrated the value of diabetes technologies in type 1 diabetes pregnancies, this level of research has not been done in pregnant women with type 2 diabetes.
“We need to start getting data around the role of technology,” said Dr. Helen Murphy, professor of medicine at the University of East Anglia and a practicing clinician at Norfolk & Norwich University Hospital in England. She explained that while 98% of pregnant women with type 1 diabetes in the UK have access to CGMs, rates of fetal deaths are higher among women with type 2 diabetes. Murphy explained that these babies “are dying because the glycemia is suboptimal.”
She said increased research among women with type 2 diabetes on the role of technology in improving maternal and fetal health was urgently needed.
Since we know that diabetes technology can help all people with diabetes manage their diabetes and avoid health complications, the panel of women’s healthcare experts likewise called for improved and expanded research on the unique challenges of women with diabetes, and how technology can address those challenges.