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Girls may face a higher rate of type 1 diabetes-related complications and poor outcomes versus boys, according to a systematic review.

Across 86 observational studies focused on sex differences in pediatric patients with type 1 diabetes, all studies that compared HbA1c at the time of diagnosis found female patients had higher HbA1c levels than males, reported Silvia de Vries, MSc, an MD/PhD candidate at Amsterdam University Medical Center in the Netherlands.

This difference persisted throughout treatment, as 20 studies found girls continued to have higher HbA1c levels than boys versus only one study that favored girls, de Vries pointed out during a presentation at the European Association for the Study of Diabetes (EASD) meeting.

The meta-analysis showed that girls required higher insulin doses than boys in the total population, in select age groups, and when just looking at the first few days after initial diagnosis. Female patients required both higher basal insulin doses and total insulin doses, the researchers found.

On the other hand, much of the literature suggested that insulin pump therapy or continuous subcutaneous insulin infusions were far more commonly used among girls with type 1 diabetes than boys.

"We think that there may be several mechanisms at play," de Vries said during a press conference. "There may be a biological influence, especially in puberty -- hormones may influence insulin sensitivity." She added that both body composition and fat distribution may be additional biological factors playing into these sex differences.

"We also think that psychological causes are very important," she continued. "Boy and girls differ in disease-related attitudes and behaviors. We already know, for example, that quality of life scores are lower in girls without diabetes, as well. But this may very well interfere with treatment of type 1 diabetes."

Boys may also have higher levels of physical activity and different eating patterns that may play into these sex differences, de Vries suggested.

Her group found that when it came to complications of diabetes, female patients faced worse outcomes for the most part: while they tended to have less hypoglycemia, they had overwhelmingly higher rates of diabetic ketoacidosis (DKA), including at diagnosis, severe DKA, and DKA throughout treatment.

Girls not only saw more hospital admissions for DKA throughout the studies included, but saw a higher rate of hospital admissions in general, along with longer length of stays. Compared with boys, they also faced more vascular complications, including nephropathy.

As for quality of life, all 15 studies (nine in adolescents alone) assessing this outcome favored male patients. Not only did female patients see poorer overall quality of life, but they also saw more diabetes-related distress and greater fear of hypoglycemia.

"We strongly believe that identification of these differences is a very important first step," de Vries said.

Nevertheless, "we cannot exclude the influence of the treatment team and caregiver approach," she pointed out. "We do know that in adult females with type 1 diabetes that there still seems to be a treatment bias."

When comparing the clinical profile of patients with type 1 diabetes, the literature indicated that female patients tended to have a longer duration of diabetes symptoms, have a higher BMI (in adolescence and at all ages), and have a higher prevalence of overweight and obesity.

In contrast, male patients had a higher prevalence of underweight, as well as weight loss before type 1 diabetes diagnosis. Boys also tended to had more favorable diastolic blood pressure and lipid profiles.

The present meta-analysis thus joins other reports of sex differences in diabetes patients. In another study presented at EASD 2022, researchers found adult women with type 2 diabetes had a significantly shorter life expectancy than men with the condition.

Both type 1 and type 2 diabetes are steadily rising in prevalence among American children and teenagers.

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