Females are more prone to obesity than males. This may lead to different outcomes. We studied if sex differences were seen in mortality outcomes in a longitudinal T2D cohort study.

Data from a regional UK database (Salford) was taken between 2010-2020. Standardised Mortality Ratio (SMR) was established from actual versus expected deaths calculated from national annual statistics for mortality rate by sex and age. The SMR was then calculated for by each sex, year, age group, HbA1c level, and diabetes medication as taken by a patient in previous years.

We included 9,558 patients with 88,102 patient years and 2,909 recorded deaths against 1,851 expected, SMR men 1.46 and women 1.72 (18% higher than men) . SMR increased slightly over time (Figure 1a) . SMR in younger females (<75 years) was higher than older females (Figure 1b) . SMR in females with high HbA1c (>86mmol/mol) was higher (Figure 1c) than lower HbA1c. Patients currently on insulin and GLP1 had much higher SMR than oral alone (Figure 1d) .SMR analysis of the oral drug use had SGLT2i 1.28; metformin 1.50; thiazolinedione 1.61; DPP4i 1.74; sulphonylurea 1.78. Note that average age and HbA1c varied across therapies.

Diabetes has greater impact on women’s mortality than men for both age, and HbA1c. Indication bias will impact drug choice but lower SMR with SGLT2i and higher with sulphonylureas concords with trial data. Despite newer therapies, SMR for diabetes has not improved over time.


A. H. Heald: None. M. Stedman: None. I. Laing: None. A. Robinson: None. G. Rayman: None. M. B. Whyte: Consultant; AstraZeneca, Research Support; AstraZeneca, Sanofi.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.