Sex differences in the control of glucose homeostasis

A markedly higher prevalence of impaired glucose tolerance has been reported in women than in men, whereas the opposite was seen for impaired fasting glucose. The present review focuses on the underlying mechanisms.

An increased meal glucose appearance and disturbances in postprandial glucose disposal may contribute to higher glucose concentrations in women. An increased, similar or reduced insulin sensitivity has been reported in women than in men, which makes it unclear to what extent a disturbed insulin-mediated glucose disposal may contribute to increased postprandial glucose concentrations in women. This discrepancy may be explained by differences in the phase of menstrual cycle during the study, the use of oral contraceptives and different degrees of physical fitness. Nevertheless, there are consistent data indicating that women are protected against fatty acid-induced insulin resistance. Furthermore, both disturbances in endogenous glucose output and metabolic clearance of glucose may contribute to the reduced fasting glucose concentrations in women.

There is an urgent need for studies that test whether sex-related disturbances in glucose metabolism may be involved in the pathogenesis of type 2 diabetes and the metabolic syndrome, taking age, menstrual cycle, the use of oral contraceptives and physical activity into account.