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Sex Differences in the Diagnosis and Management of Heart Failure Among Outpatients with Type 2 Diabetes

Rafael Gonzalez-Manzanares1,2,3, María Anguita-Gámez4, Javier Muñiz3,5

  • 1Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.

Journal of Women'S Health (2002)
|December 26, 2025
PubMed

Insights

Heart failure (HF) and type 2 diabetes (T2D) affect men and women similarly in prevalence and prognosis. However, women with T2D present more often with HF with preserved ejection fraction (HFpEF) and receive less guideline-directed therapy.

Area of Science:

  • Cardiology
  • Endocrinology
  • Sex-based Medicine

Background:

  • Type 2 diabetes (T2D) and heart failure (HF) frequently coexist, leading to adverse outcomes.
  • Exploring sex-related differences in HF presentation and outcomes within a T2D population is crucial.

Purpose of the Study:

  • To investigate sex-based disparities in the characteristics, treatment, and 3-year clinical outcomes of heart failure among patients with type 2 diabetes.

Main Methods:

  • A prospective cohort study of 1,249 type 2 diabetes outpatients across 30 Spanish centers.
  • Heart failure classified by left ventricular ejection fraction (LVEF): HFrEF (<40%), HFmrEF (40-49%), and HFpEF (≥50%).
  • Assessment of sex-related differences in HF presentation, treatment patterns, and 3-year clinical outcomes.

Main Results:

  • HF prevalence was similar between sexes at baseline and 3 years.
  • Women predominantly presented with HFpEF, while men showed a higher prevalence of HFrEF (p < 0.001).
  • Women with HFrEF received fewer angiotensin receptor-neprilysin inhibitors, and women with HFpEF were more often treated with diuretics compared to men.

Conclusions:

  • Despite similar HF prevalence and prognosis in T2D patients, significant sex-based differences exist in HF presentation, favoring HFpEF in women.
  • Women with HF were less likely to receive optimal guideline-directed medical therapies, highlighting a need for sex-specific management strategies.
Abstract

Keywords:
diabetesheart failurewomen

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