Sex differences in glucose-regulating neurohormonal pathways-potential impact for type 2 diabetes development

Men have a higher risk to develop type 2 diabetes (T2D) than women. The aim of this study was to investigate if there are sex differences in counter-regulatory hormone dynamics that might affect insulin resistance and hence propensity for T2D. Further, we addressed the roles of sex hormones, menopausal status and metabolic phenotypes for such sex differences.

22 men (7 T2D, BMI 28.8 kg/m²) and 28 women (16 postmenopausal, 9 T2D, BMI 31.5 kg/m²) underwent euglycemic-hyperinsulinemic-hypoglycemic and hyperglycemic clamps with assessments of counter-regulatory hormones and heart rate variability (HRV). Sex hormones (eg, testosterone, estradiol) were analyzed from fasting plasma samples.

Men vs women had higher responses of glucagon, ACTH, cortisol and GH but attenuated HRV responses during hypoglycemia and higher ACTH, more sympathetic dominance and lower GH levels during normo- and hyperglycemia. Post- vs premenopausal women had lower GH levels and less favorable HRV profiles but did not otherwise differ. Within-sex correlations between neurohormonal responses and sex hormones were generally weak. In multilinear regressions, M-value and waist-to-hip ratio were the strongest predictors of cortisol, ACTH and GH responses, whereas sex hormones did not explain within- or between-sex variations in neurohormonal responses.

In healthy individuals as well as those with obesity or T2D, glucose-dependent counter-regulatory hormonal responses are elevated in men vs both pre- and postmenopausal women. This may contribute to insulin resistance and hence an increased risk of T2D development in men. Central adiposity, but not sex hormone profiles, may partly explain the observed sex differences.