In July 2010, during the FIFA Football World Cup in South Africa, 16-year-old Kirsten De Klerk, now an International Diabetes Federation (IDF) Young Leader in Diabetes, invited friends for a sleepover to watch a match. One of her friends had the flu, and she caught it. Instead of getting better, her health deteriorated. After seeing a doctor, she was diagnosed with bronchitis and sent home with antibiotics. Two weeks later, she still had not recovered and had lost 10kg. Following a second doctor’s visit and a series of blood tests, Kirsten was diagnosed with type 1 diabetes.
When Kirsten wanted to learn more about her condition, how it impacted her hormones or the interplay of contraceptives and type 1 diabetes, she found little information on which to base her research.
Diabetes is often discussed in broad strokes without fully reckoning with the distinct challenges women face. Yet, from puberty to menopause, hormonal shifts shape diabetes management. Meanwhile, gaps in diabetes screening and research continue to leave women navigating this condition with inadequate support.
Diabetes is often discussed in broad strokes without fully reckoning with the distinct challenges women face.
Before 1993, women were rarely included in clinical trials. Approximately half of all people with diabetes are women, but gaps remain in the inclusion of women in diabetes research and in understanding how medicines and devices affect them.
Furthermore, even though diabetes complications present differently in women, gender equity is often absent in clinical and pre-clinical trials. Women with type 1 diabetes have almost twice the risk of developing cardiovascular complications than men with the same condition and a greater risk of premature death from diabetes-related complications. Similarily, women with type 2 diabetes are almost twice as likely to develop cardiovascular disease (CVD) as men with the condition and have a higher risk of stroke. Moreover, women generally receive a CVD diagnosis four years later than men. This later diagnosis increases their risk of complications.
Two reasons that could explain this higher risk are that diabetes affects women’s cardiovascular health differently, particularly those with type 1 diabetes and hormones. Oestrogen generally improves insulin sensitivity, but the presence of other hormones like progesterone can limit its effect. Progesterone tends to decrease insulin sensitivity, particularly after ovulation and during pregnancy.
Although diabetes complications present differently in women, gender equity is often absent in clinical and pre-clinical trials.
Puberty can be a tumultuous time of physical and hormonal change. For young girls with diabetes, it can be particularly demanding. The hormones oestrogen and progesterone affect insulin sensitivity and often cause fluctuations in blood sugar levels before menstruation. These fluctuations, in turn, impact treatment plans and insulin doses. Yet, too many young women enter this phase without the tools to adjust insulin or manage sudden metabolic shifts due to a lack of information on how menstruation influences glucose regulation.
Kirsten wanted more information to understand how hormones affect diabetes and why her glucose levels fluctuated during the month. She struggled to find evidence-based or science-based answers to her queries from healthcare professionals. Often, she found answers from other women living with diabetes who could share their personal experiences.
Technological developments in diabetes management have become a valuable solution to this dilemma. Using a Continuous Glucose Monitor (CGM) can help track these fluctuations by providing almost real-time glucose readings that allow people to adjust their insulin or treatment to glucose levels.
Too many young women enter puberty without the tools to adjust insulin or manage sudden metabolic shifts due to a lack of information on how menstruation influences glucose regulation.
Pregnancy is a delicate balancing act for any woman, but for those with diabetes, it demands near-perfect blood glucose management. Despite common misperceptions, women with diabetes can have children. If they decide to have a child, women with type 1 and type 2 diabetes can encounter certain risks. Nevertheless, a healthy pregnancy and baby are possible with an adapted treatment plan and attentive blood glucose management. Poor glucose management can lead to preterm birth, preeclampsia or complications for the baby.
Anita Sabidi, a Blue Circle Voices member from Indonesia, is the mother of two boys but also experienced two miscarriages. Anita strongly advocates for planning your pregnancy. When she decided to start a family, she assembled a multidisciplinary team with her endocrinologist, obstetrician-gynecologist and cardiologist. Having this team to support her made insulin management and treatment during her pregnancy much easier.
In addition to women with diabetes, gestational diabetes (GDM) affects approximately one in six pregnancies. Yet, postpartum care remains seriously inconsistent. Many women who develop GDM never receive follow-up screenings despite the well-documented risk of developing type 2 diabetes later in life. Whilst GDM typically resolves after childbirth, people who have experienced GDM are much more likely to develop type 2 diabetes later, making them susceptible to diabetes-related complications such as CVD. Despite this risk, awareness remains a fundamental problem, mainly when postpartum screenings are optional rather than essential.
Studies suggest that breastfeeding reduces the risk of developing CVD in women with diabetes, yet even healthcare providers are frequently unaware of its protective effects. In 2024, findings from a major study involving two cohorts, women with type 2 diabetes and women with gestational diabetes, revealed the considerable benefits of breastfeeding. Women with type 2 diabetes who breastfed for at least 18 months had a lower risk of CVD and coronary heart disease compared to those who did not breastfeed. The protective effect was even more noticeable in women with GDM.
Studies suggest that breastfeeding reduces the risk of developing CVD in women with diabetes, yet even healthcare providers are frequently unaware of its protective effects.
Global programmes are tackling these disparities, particularly in low- and middle-income countries where they are the most needed. The Women in India with GDM Strategy (WINGS project) was an IDF project from 2012 to 2016 aimed at tackling gestational diabetes detection and management in low-resource settings. Project outcomes included guidelines for healthcare professionals on cost-effective screening for GDM and follow-up screening.
Similar to the WINGS project, Kenya’s Linda Mama initiative integrates diabetes screening into free maternal healthcare services. These initiatives offer a more comprehensive approach to ensure diabetes care does not end in the delivery room.
If puberty and pregnancy bring well-documented transitions, menopause is still a forgotten area of diabetes care and women’s care in general. During perimenopause, the transitional phase leading up to menopause, oestrogen and progesterone changes can affect blood glucose levels, often leading to higher glucose levels due to increased insulin resistance. Symptoms of menopause—fatigue, mood swings, weight gain—often mask diabetes-related complications, making management even more complex.
When Dawn Adams, a Blue Circle Voices member from the United Kingdom who lives with type 1 diabetes, began perimenopause, she could not maintain stable glucose levels regardless of physical activity, nutritional adjustments and sleep quality. She felt like the cards were stacked against her on every front. Fortunately, her family doctor listened and prescribed hormone replacement therapy (HRT).
HRT can provide several benefits for perimenopausal women in general and women with diabetes, including improved insulin sensitivity, more stable blood glucose levels, and relief from menopausal symptoms that interfere with diabetes management. Yet, only in the past seven years have we started to see clinical guidelines that address menopause and diabetes management.
After Dawn began HRT with set doses of oestrogen and progesterone, she was able to maintain stable blood glucose levels, something that she tried to tackle for almost 30 years. Because the hormone doses are set, she no longer has to deal with the fluctuations she experienced as an adolescent, during pregnancy and while breastfeeding.
HRT can provide several benefits for perimenopausal women in general and women with diabetes, including improved insulin sensitivity, more stable blood glucose levels, and relief from menopausal symptoms that interfere with diabetes management.
Beyond individual treatment, diabetes in women is a systemic issue—one shaped by gender bias in research, inadequate policies and the menopause blind spot. The IDF Women and Diabetes Working Group has pushed for better screening and policy reforms, but more is needed. One persistent challenge is the poor attendance at postpartum diabetes screenings, a missed opportunity for early intervention. Another is the underrepresentation of women in diabetes research, particularly concerning cardiovascular risk.
Closing the gaps in diabetes care for women requires:
Diabetes is a lifelong condition, but it does not have to be a solitary journey for women. With better research, targeted policies and stronger advocacy, we can ensure that women receive the care and attention they deserve—at every stage of life.
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