When Sex Shapes Diabetes Care: Evidence from the AMD Annals Registry

BACKGROUND: Sex and gender differences substantially influence the epidemiology, clinical presentation, and outcomes of type 2 diabetes (T2D). Although guideline-recommended cardiometabolic therapies have expanded in recent years, evidence suggests that women with T2D continue to experience disparities in risk factor control, access to cardioprotective treatments, and clinical outcomes. This study aimed to evaluate sex-based differences in quality of care, treatment patterns, and clinical inertia using real-world data from the Associazione Medici Diabetologi (AMD) Annals Initiative. METHODS: We conducted a cross-sectional analysis of 2023 data from 296 diabetes clinics participating in the AMD Annals registry. Adults with active T2D (≥1 antidiabetic prescription and ≥1 clinical assessment in 2023) were included. Process indicators, intermediate outcomes, pharmacologic treatments, and final outcomes were assessed according to AMD Indicators (Revision 9). All analyses were stratified by sex. RESULTS: The study included 571,962 individuals with T2D (41.5% women). Glycemic control and overall quality-of-care scores were similar between sexes. However, women exhibited higher BMI, greater prevalence of severe obesity, poorer lipid control, and higher rates of reduced eGFR. Despite comparable or higher cardiometabolic risk, women were less frequently monitored for albuminuria and retinopathy and were significantly less likely to receive SGLT2 inhibitors and GLP-1 receptor agonists, particularly in the presence of chronic kidney disease, cardiovascular disease, or heart failure. Indicators of clinical inertia consistently disadvantaged women, especially regarding cardioprotective therapies. CONCLUSIONS: Despite comparable overall quality-of-care scores, clinically meaningful sex disparities persist in T2D management in Italy. Women experience a higher burden of metabolic risk and reduced access to evidence-based cardioprotective treatments. These findings highlight the urgent need for gender-sensitive diabetes care strategies to reduce therapeutic inequities and improve cardiovascular and renal outcomes in women with T2D.