Sex-based differences in perceived glycaemic control in T1D
Coco M. Fuhri Snethlage, Paul Smeets, Pleun de Groen, Elena Rampanelli, Daniël H. van Raalte, J. Hans DeVries, Abraham S. Meijnikman, Sarah Siegelaar, Bastiaan E. de Galan, Bart O. Roep, Max Nieuwdorp, and Nordin M.J. Hanssen
Sex-based disparities in perceived versus objective glycaemic control in type 1 diabetes: a cross-sectional cohort study. Lancet Diabetes Endocrinol. 2025 Sep;13(9):739-741.
Managing type 1 diabetes requires balancing insulin dosing to avoid both hypoglycaemia and hyperglycaemia. This study examined whether men and women differ in how accurately they perceive their diabetes management compared to objective continuous glucose monitoring (CGM) data.
Using data from 496 adults with type 1 diabetes (180 men, 316 women) from the Dutch GUTDM1 cohort, researchers compared self-rated diabetes control with CGM-derived time in range (TIR) and hypoglycaemia data. Two indices were developed:
- Diabetes Management Index (DMI): comparing self-rated control to actual TIR.
- Hypo-Estimation Index (HEI): comparing reported vs. CGM-measured hypoglycaemic events.
Key findings:
- Objective control was similar between women and men (median TIR ≈ 67% vs. 66%; HbA1c 56.2 vs. 54.3 mmol/mol).
- Subjective perception differed strongly:
- Women rated their diabetes control lower than men (median 6.0 vs. 7.0 on a 0–10 scale, p<0.0001).
- Women’s DMI was near 1.0 (accurate), while men’s was 1.31 (p=0.034), indicating a 31% overestimation of their actual glycaemic control.
- Hypoglycaemia:
- Men had more CGM-detected hypoglycaemic events but underreported them more than women (HEI –0.55 vs. –0.38, p=0.030).
- Women’s reporting correlated more closely with CGM data.
- These results were consistent after adjusting for age, BMI, diabetes duration, insulin mode, and CGM type.
Concluding, the authors state
"These findings have important clinical implications. They can help people with type 1 diabetes better align their perception of glucose control with actual CGM data. Furthermore, the results also highlight the importance of using recent CGM metrics instead of relying on general impressions when assessing glycaemic control." -
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