Do women and men develop different problems after type 2 diabetes?
Yes. Women were more likely to be diagnosed with a mental health condition next, and men were more likely to be diagnosed with heart or kidney disease. In 28,720 UK adults newly diagnosed with type 2 diabetes, 8.1% of women went on to a mental health diagnosis compared with 5.3% of men, while 8.4% of men developed heart or kidney disease compared with 5.3% of women.
Most research on type 2 diabetes complications looks at each problem on its own. It tells you that diabetes raises your risk of heart disease, and separately that it raises your risk of depression. What it does not tell you is which one tends to show up first, and when.
Researchers at Queen Mary University of London went after that question. They used anonymous NHS records from the UK Clinical Practice Research Datalink, starting from a source population of 3,984,233 adults registered with an English GP between 2010 and 2020. From that pool they identified 28,720 people with a new type 2 diabetes diagnosis and followed them for a median of 6.8 years. Then they used a method called multi-state modelling, which tracks the order, timing, and combination of conditions each person picked up rather than counting each condition in isolation.
What the data show
Over the follow-up period, 39% of the group (11,161 people) had at least one new health event after their diabetes diagnosis. The order those events came in split sharply by sex.
A mental health diagnosis, meaning anxiety, depression, or a somatoform disorder, came next for 8.1% of women and 5.3% of men. That is about 28 more women per 1,000 than men, or roughly 53% more in relative terms. Heart or kidney disease ran the other way, affecting 8.4% of men and 5.3% of women, which works out to about 31 more men per 1,000, or roughly 58% more in relative terms.
High blood pressure was the single most common next event for both sexes, and the sexes were close there: 21.1% of men and 20.2% of women. The divergence appeared at the step after that. Among people who developed high blood pressure first, women were about 75% more likely than men to be diagnosed with a mental health condition next (8.6% versus 4.9%), a gap of about 37 more per 1,000 women.
The mortality signal is the part that matters most. In both sexes, the sequence that ended in the earliest death was diabetes followed by a mental health condition. Men on that path died at a median age of 61, nine years younger than women on the same path, who died at a median age of 70. Men reached that point despite using healthcare far less: across the whole study period, women averaged 92 primary care consultations to men’s 32, and 3 hospital admissions to men’s 1.
Dr. Kumar’s Take
The temptation with a finding like this is to file mental health under “understandable, given the diagnosis” and move on. This study argues against that. The people whose diabetes was followed by anxiety or depression were the ones who died youngest, in both sexes, across every trajectory the researchers mapped. That makes a mental health diagnosis a marker of how the next decade is likely to go, not a footnote to the metabolic problem.
The 9-year gap between men and women on that same path is the number I keep weighing. Men died younger while consulting a GP roughly a third as often. That combination points at undertreatment rather than a different disease.
Women use healthcare more, so women get diagnosed more, and some of the mental health gap between the sexes may be a difference in who gets recorded rather than who is affected. The authors say so directly. That caution cuts a specific way though: it makes it more likely that the men in this cohort had untreated anxiety and depression, not less.
When each problem tends to show up
Age at onset separated the two sexes as clearly as the type of complication did. Mental health conditions arrived at the youngest ages of any event, with a median age of 50 in women and 51 in men. Heart and kidney disease came earlier in men, whose earliest median age for that diagnosis was 60, against 66 in women. Women were also about 2 years older than men when their diabetes was first diagnosed, at 56 versus 54.
Age shaped the risk within each sex too. Women aged 16 to 39 had the highest probability of a mental health diagnosis after diabetes of any group in the study. For women over 60, that probability fell while the probability of heart disease, kidney disease, or death climbed. Men followed a steadier path toward high blood pressure that strengthened with age.
How strong is the evidence?
This is a large, nationally representative dataset analysed with a method built for exactly this question, which is a real strength. It is still descriptive. It shows the order in which conditions appeared, not that one condition caused the next, and the authors are explicit that causal studies are needed before anyone claims otherwise.
Three limits are worth holding onto. Conditions were counted only if a clinician coded them in the record, so anything undiagnosed is invisible here. Causes of death could not be examined separately. Ethnicity could not be analysed because the numbers in each trajectory were too small.
Practical Takeaways
- If you or someone in your family has been diagnosed with type 2 diabetes, treat a change in mood, sleep, or anxiety as part of the diabetes picture and raise it at a routine appointment rather than waiting for it to pass.
- Men with type 2 diabetes had the earliest deaths on the mental health path while attending primary care about a third as often as women, so keeping scheduled reviews matters more than the low symptom burden suggests.
- Blood pressure was the most common complication after diabetes in both sexes across every age group, which makes regular blood pressure checks the highest-yield thing to keep track of after a new diagnosis.
- Younger women, particularly those diagnosed with diabetes before 40, carried the highest probability of a mental health diagnosis in this cohort, so screening should not wait until later life.
Related Studies and Research
- Depression management in primary care: clinical update and best practices
- Finerenone slows kidney decline in people without diabetes
- Paying attention to your body while daydreaming may protect against depression and ADHD
- Does high LDL-C help elderly people live longer? A review of 19 studies
FAQs
Why would type 2 diabetes lead to depression or anxiety?
The study tracked the sequence rather than the mechanism, so it cannot answer this directly. The authors note that the relationship runs both ways: depression is also linked to a higher risk of developing type 2 diabetes in the first place. They also point to shared biology behind somatoform disorders and diabetes, including inflammation, problems with the automatic nervous system that controls things like heart rate and digestion, and imbalances in brain chemical messengers. Unexplained physical symptoms are common in type 2 diabetes, which makes it hard to tell a somatic symptom from a diabetes-related one.
Does this mean women with type 2 diabetes do not need to worry about heart disease?
No. Women had a lower probability of heart or kidney disease than men of the same age, but the picture changed with age. Women over 60 had a rising probability over time of either dying or developing heart or kidney disease. Among people who did develop heart or kidney disease after their diabetes diagnosis, women had a higher proportion of deaths from any cause than men, 25.8% versus 18.1%. The sex difference in this study is about which complication tends to come first and when, not about who is exempt.
What counted as a mental health condition in this study?
The researchers grouped anxiety, depression, and somatoform disorder together into a single category. A somatoform disorder means physical symptoms that cause real distress and drive medical visits without a clear physical explanation. They were included because they overlap heavily with diabetes symptoms, push up healthcare use, and are linked to a higher risk of depression and anxiety. Because conditions were identified from diagnostic codes in the medical record, anyone whose symptoms never reached a clinician’s notes would not appear in these figures.
Bottom Line
Following 28,720 UK adults for a median of 6.8 years after a type 2 diabetes diagnosis showed two different roads out of the same diagnosis: women more often toward anxiety and depression, men more often toward heart and kidney disease. The common thread is that whoever ended up with a mental health condition alongside diabetes died youngest, and men on that path died nine years earlier than women while using healthcare far less. Mental health belongs inside diabetes care, not beside it.
