Gender Differences in Diabetes Technology: Adherence and Outcomes-A Systematic Review

Background/Objectives: Diabetes management technologies-including continuous glucose monitors (CGM), insulin pumps (CSII), advanced hybrid closed-loop (AHCL) systems, and mobile health applications-have transformed diabetes care, yet gender-specific differences in ad-herence, clinical outcomes, and patient-reported outcomes remain inadequately char-acterised. Methods: We conducted a systematic literature review following PRISMA 2020 guide-lines, searching SciSpace, Google Scholar, and PubMed databases. From 852 identified records, 500 underwent title/abstract screening after duplicate removal; 16 studies were ultimately included in the qualitative synthesis. Results: Included studies examined insu-lin pumps (n = 7), CGM (n = 6), AHCL systems (n = 4), remote monitoring programmes (n = 2), and mobile health applications (n = 1); sample sizes ranged from 72 to 22,697 participants. In predominantly paediatric evidence, females demonstrated higher insu-lin pump discontinuation rates (discontinuation groups: 75% vs. 46%, p = 0.001), driv-en by body image concerns and device visibility (data from a single small predomi-nantly paediatric cohort; group sex compositions, not absolute discontinuation rates), whereas in a single small adult cohort (n = 72), males showed poorer adherence to in-termittently scanned CGM (approximately four fewer scans/day, p = 0.011). Glycaemic outcomes were modestly but consistently different: males achieved slightly higher time-in-range while females exhibited lower glycaemic variability; menstrual cycle effects on glycaemic control were partially mitigated by AHCL systems. Females con-sistently reported greater diabetes-related distress and a more negative perception of glycaemic control despite similar or better objective metrics. Conclusions: In conclusion, sex-based and gender-related differences are apparent across technology type, adherence, gly-caemic control, and psychosocial outcomes-albeit from a limited evidence base re-quiring cautious interpretation; sex-sensitive prescription, education, and technology design are warranted. Note: most included studies reported biological sex (male/female) rather than self-identified gender; conclusions should be interpreted primarily as sex-based differences.