Gender is a meaningful risk factor for diabetes, and it works differently than most people expect. In the United States, 18% of adult men have diabetes compared to 13.7% of women, based on CDC data from 2021 to 2023. Globally, an estimated 17.7 million more men than women have diabetes. But that gap shifts with age, and the reasons behind it involve hormones, body fat distribution, and even the social roles people fill in daily life.
Men Face Higher Overall Risk, but the Gap Narrows With Age
In young and middle-aged adults, men consistently show higher rates of type 2 diabetes. A large study in the Journal of Clinical Endocrinology and Metabolism found that 14.6% of men had type 2 diabetes compared to 9.1% of women. After adjusting for physical activity and smoking, men had roughly twice the odds of developing the disease.
That picture changes later in life. After age 60, women experience sharper rises in blood sugar after meals, which contributes to a higher rate of undiagnosed diabetes in older women. By age 70, total diabetes prevalence in women catches up to or exceeds that of men. This shift is closely tied to menopause and the hormonal changes that come with it.
Where Your Body Stores Fat Matters More Than How Much You Carry
The single biggest reason men develop type 2 diabetes at higher rates is visceral fat, the deep abdominal fat that surrounds internal organs. In the same study that found men had twice the diabetes odds, the average man carried about 1,987 grams of visceral fat compared to 1,077 grams in women. Their BMI difference was small (27.3 vs. 26.6), but the visceral fat gap was enormous.
Here’s the striking finding: when researchers accounted for visceral fat, the increased risk of being male disappeared entirely. The odds ratio dropped from nearly double to below 1.0, meaning sex itself wasn’t the problem. It was the fat packed around the organs. Men tend to store fat in this pattern (sometimes called an “apple shape”), while women before menopause tend to store fat in the hips and thighs, which is far less metabolically harmful.
How Hormones Protect and Harm
Estrogen plays a protective role in blood sugar regulation. It improves insulin secretion and helps cells respond to insulin more effectively. This is a key reason premenopausal women have lower diabetes rates than men of the same age. When estrogen levels drop during menopause, that protection fades. Women who go through early menopause or have their ovaries surgically removed tend to have less favorable blood sugar and insulin levels, pointing to a direct link between estrogen loss and rising diabetes risk.
Menopause also shifts the hormonal balance toward relatively higher androgen (male hormone) levels and lower levels of a protein that binds sex hormones. This increased androgen influence has been independently linked to higher type 2 diabetes risk in postmenopausal women.
In men, the relationship runs in the opposite direction. Low testosterone is associated with poorer insulin sensitivity and a threefold higher prevalence of metabolic syndrome, a cluster of conditions that includes high blood sugar, excess belly fat, and abnormal cholesterol. Research published by the American Diabetes Association found a clear positive correlation between testosterone levels and insulin sensitivity in men, along with better cellular energy production. So while excess androgens raise risk in women, insufficient androgens raise risk in men.
Female-Specific Risk Factors
Two conditions unique to women create additional pathways to type 2 diabetes. Polycystic ovary syndrome (PCOS), which affects roughly 1 in 10 women of reproductive age, carries a dramatic risk: more than half of women with PCOS develop type 2 diabetes by age 40, according to the CDC. PCOS involves elevated androgen levels and insulin resistance, creating a cycle where each condition worsens the other.
Gestational diabetes, which develops during pregnancy, is another red flag. Women who experience it have a substantially higher lifetime risk of developing type 2 diabetes in later years. Both of these conditions are well-established screening triggers, meaning if you’ve had either one, your doctor should be monitoring your blood sugar regularly going forward.
Gender Roles Shape Self-Management
Beyond biology, the social roles tied to gender affect how people manage diabetes once they have it. Research on self-management behaviors reveals a consistent pattern: women with diabetes tend to prioritize family caregiving over their own health needs. They report neglecting dietary plans and skipping physical activity because they lack time after caring for children, partners, or aging parents. Many women describe this caregiving role as something they do “for love” and “as always,” so deeply embedded in their identity that their own health becomes secondary.
Men face a different set of barriers. Many rely heavily on a spouse to manage their diet, with some describing their wife as a “supervisor” for meal planning. Men also tend to resist emotional engagement with their diagnosis, framing self-sufficiency and stoicism as masculine values. This reluctance to acknowledge vulnerability can make it harder to seek help, follow treatment plans, or attend support programs. Men in studies identified the difficulty of balancing work with self-care as their primary obstacle, while women pointed to lack of time from caregiving and low mood.
Women With Diabetes Face Worse Heart Outcomes
One of the most consequential gender differences in diabetes isn’t about who gets the disease. It’s about what happens afterward. Women with type 2 diabetes face a relative risk of cardiovascular disease roughly twice as high as men with the same condition. In one study, women with diabetes had a 9.3 times higher risk of heart disease compared to women without diabetes, while men with diabetes had a 4.6 times higher risk compared to healthy men.
For serious cardiovascular events like heart attacks and strokes, the pattern held in long-term follow-up: women with diabetes had a 5.25 times higher relative risk, versus 2.72 times for men. This means diabetes erases more of the cardiovascular protection that women typically enjoy before developing the disease. It’s one reason aggressive heart health monitoring matters for women with type 2 diabetes, even though they’re diagnosed less often overall.
Screening Rates Are Similar, but Outcomes Differ
There’s little evidence that men and women receive different levels of diabetes screening. CDC research comparing men and women with type 2 diabetes found no significant difference in whether they received blood sugar tests, cholesterol checks, or eye exams. Women actually had higher rates of scheduling and attending medical appointments.
Yet men in the same study had significantly higher median blood sugar levels despite similar access to care, suggesting that diagnosis and screening aren’t the bottleneck. The gap likely reflects differences in day-to-day management, diet, and the self-care challenges described above. The real disparity isn’t in who gets tested but in how effectively each person can act on what the tests reveal.