Diabetes - Women

Diabetes - Women in United States

United States

Diabetes interrupts the body's ability to use insulin, a hormone that converts food into energy for the body. People with diabetes are more likely to have an accumulation of glucose (i.e., food broken down into sugar) in the blood, which can lead to serious health problems such as heart disease, vision loss and kidney disease. Diabetes is the seventh-leading cause of death among women. There are three different types of diabetes:

• Type 2 diabetes occurs when the body cannot use insulin appropriately to regulate blood sugar levels. Approximately 90-95% of diabetes cases are type 2.
• Type 1 diabetes is thought to be caused by an autoimmune reaction that prevents the body from making insulin. Approximately 5-10% of diabetes cases are type 1.
• Gestational diabetes develops in pregnant women who have never had diabetes. It can increase the risk of developing type 2 diabetes for both mother and child later in life.

Risk factors for developing diabetes include obesity or overweight, weight gain during adulthood and a family history of type 1 or 2 diabetes.

For women of reproductive age, diabetes increases the risk of adverse pregnancy outcomes. Compared with women without diabetes, women with any type of diabetes during pregnancy are at increased risk of preeclampsia, preterm delivery, miscarriage or stillbirth. 

Increasing insulin prices are raising the overall costs of health care spending on diabetes. Insulin under-use is becoming more common — approximately 1 in 4 Americans with diabetes cannot afford the amount of insulin prescribed by their doctors. The total estimated direct and indirect cost of diabetes in the United States was $327 billion in 2017. Individual costs vary; however, excess medical expenditures associated with diabetes increased from $8,417 to $9,601 per person between 2012 and 2017.

The prevalence of diabetes is higher among: 

• Women ages 35-44 compared with those ages 25-34 and 18-24.
• Multiracial, Black, American Indian/Alaska Native and Hispanic women compared with white and Asian women. 
• Women with less than a high school education compared with those with a college degree.
• Women with an annual household income of less than $25,000 compared with those with a household income of $75,000 or more; the prevalence decreases with each increase in income level.
• Women living in non-metropolitan areas compared with women in metropolitan areas.

Prediabetes and type 2 diabetes are largely preventable. Interventions that promote maintaining a healthy weight and diet and avoiding smoking and physical inactivity can prevent type 2 diabetes and greatly reduce the overall burden of the disease. 

For those with diabetes, complications can be prevented through adherence to medications, lifestyle changes and health care interventions. For women of reproductive age with preexisting diabetes, managing the condition is critical prior to conception and during the first trimester to reduce the risk of adverse outcomes for both infant and mother. Research indicates that diabetes-related complications during pregnancy may be prevented with a healthy diet, regular physical activity and medication modifications.

The Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program offers resources to support lifestyle changes and prevent or delay diabetes.

Healthy People 2030 has several diabetes-related objectives, including reducing the annual number of newly diagnosed diabetes cases and the death rate among those with diabetes.

Centers for Disease Control and Prevention. “National Diabetes Statistics Report 2020.” Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html.

Galaviz, Karla I., K. M. Venkat Narayan, Felipe Lobelo, and Mary Beth Weber. “Lifestyle and the Prevention of Type 2 Diabetes: A Status Report.” American Journal of Lifestyle Medicine 12, no. 1 (January 2018): 4–20. https://doi.org/10.1177/1559827615619159.

Luo, Jing, and Walid F. Gellad. “Origins of the Crisis in Insulin Affordability and Practical Advice for Clinicians on Using Human Insulin.” Current Diabetes Reports 20, no. 1 (January 2020): 2. https://doi.org/10.1007/s11892-020-1286-3.

Negrato, Carlos Antonio, Rosiane Mattar, and Marilia B. Gomes. “Adverse Pregnancy Outcomes in Women with Diabetes.” Diabetology & Metabolic Syndrome 4, no. 1 (December 2012): 41. https://doi.org/10.1186/1758-5996-4-41.

Schulze, Matthias B., and Frank B. Hu. “Primary Prevention of Diabetes: What Can Be Done and How Much Can Be Prevented?” Annual Review of Public Health 26, no. 1 (April 21, 2005): 445–67. https://doi.org/10.1146/annurev.publhealth.26.021304.144532.