During the International Diabetes Federation World Diabetes Congress (IDF 2025), Professor Chantal Mathieu from University Hospitals Leuven, Belgium, gave an interview focusing on the integrated diabetes, cardiorenal and metabolic management model, addressing key issues including special prevention and treatment strategies for women and medication selection.
Professor Chantal Mathieu pointed out that the relationships between women and type 2 diabetes (T2DM), as well as women and cardiovascular diseases, are highly complex. We are all taught that “estrogen provides protection for the female cardiovascular system”. This view is indeed evidence-based: premenopausal women have a lower incidence of cardiovascular diseases than men, but this protective advantage disappears after menopause. However, numerous studies have revealed that when postmenopausal women present to the emergency department with angina, doctors often do not prioritize cardiovascular disease as a possible diagnosis—a phenomenon rooted in the deep‑seated belief of “estrogen protection”. This directly results in a generally delayed diagnosis of myocardial infarction in women compared with men.
“Estrogen protection” masks the real risk of postmenopausal women: among overweight/obese individuals, women are more likely to develop T2DM; postmenopausal women experience a rapid accumulation of cardiovascular risk factors. Yet due to fixed “gender bias”, women in clinical practice, especially female patients with diabetes, are much less likely to receive statins, and have lower achievement rates for blood pressure, lipid and blood glucose targets. More worryingly, even in large cardiovascular outcome trials of novel antidiabetic drugs, the organ‑protective effects of these medications are identical in women and men, yet they are significantly underused in women. Therefore, I proposed an initiative at the IDF Congress: outdated concepts must be abandoned! Postmenopausal women with T2DM are actually at extremely high risk of cardiovascular diseases. Clinicians must proactively conduct risk screening, actively prescribe organ‑protective drugs such as novel antidiabetic agents, and eliminate gender disparities in treatment.
Regarding pharmacotherapy for female patients with diabetes, Professor Chantal Mathieu noted that initially, SGLT2 inhibitors and GLP‑1 receptor agonists were defined as glucose‑lowering drugs. With the release of results from large‑scale studies, we have found that the effects of these drugs extend far beyond glycemic control. They have been proven to exert cardioprotective and renoprotective effects and significantly improve patient prognosis. This has laid the foundation for recommending these drugs as first‑line treatments.
However, in women, we should recognize that the efficacy of these drugs shows no gender difference—both SGLT2 inhibitors and GLP‑1 receptor agonists provide identical cardiovascular and renal benefits in men and women. Nevertheless, in clinical practice, gender‑specific adverse reactions still require vigilance:
During treatment with SGLT2 inhibitors, women are more prone to genital tract infections (such as candidiasis) and urinary tract infections. Therefore, infection history should be evaluated, the drugs should be used cautiously in patients with recurrent infections, and education—especially personal hygiene guidance—should be strengthened.
For GLP‑1 receptor agonists, gastrointestinal adverse reactions (such as nausea and vomiting) may occur, but their incidence is similar in men and women, with no gender‑specific contraindications.