[Sex and gender-specific aspects in prediabetes and diabetes mellitus - Clinical recommendations (Update 2026)].

In the clinical routine treating physicians are confronted with the different needs of women and men, which change during their lifetime. Gender-specific differences influence the pathophysiology, screening, diagnostic and treatment strategies of diabetes as well as the development of complications and mortality rates. Alterations in glucose and lipid metabolism, regulation of energy balance and body fat distribution as well as diabetes-associated comorbidities, are greatly influenced by steroidal and sex hormones as well as by lifestyle, environmental factors, income and psychosocial factors. Males appear to have a greater risk for type 2 diabetes (T2DM) at a younger age and at a lower body mass index (BMI) compared to women but women show a higher BMI and more often hypertension at diagnosis and are affected by a dramatic increase in the risk for cardiometabolic diseases after the menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, whereby the higher mortality is mainly attributable to vascular complications. The increased mortality due to cancer in men with diabetes seems to bear more weight than by women. Both sexes benefit from prevention programs with a reduction in the risk for T2DM. Men predominantly feature increased fasting blood glucose levels, women often show impaired glucose tolerance. A history of gestational diabetes or increased androgen levels in women and the presence of erectile dysfunction or decreased testosterone levels in men are important sex-specific diabetes risk factors. Many studies showed that women with diabetes reach their target values for glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein (LDL)-cholesterol less often than men. Sex differences in the effects, pharmacokinetics and side effects of pharmacological treatment should be taken more into consideration with better achievement of individual target levels in men and women.