Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis

Lancet Diabetes Endocrinol. 2015 Mar;3(3):198-206. doi: 10.1016/S2213-8587(14)70248-7. Epub 2015 Feb 6.


Background: Studies have suggested sex differences in the mortality rate associated with type 1 diabetes. We did a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes.

Methods: We systematically searched PubMed for studies published between Jan 1, 1966, and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. We used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes.

Findings: Data from 26 studies including 214 114 individuals and 15 273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·37 (95% CI 1·21-1·56), for incident stroke 1·37 (1·03-1·81), for fatal renal disease 1·44 (1·02-2·05), and for fatal cardiovascular diseases 1·86 (1·62-2·15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2·54 (95% CI 1·80-3·60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide.

Interpretation: Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes.

Funding: None.

Publication types

  • Historical Article
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Analysis of Variance
  • Diabetes Complications / mortality*
  • Diabetes Mellitus, Type 1 / history
  • Diabetes Mellitus, Type 1 / mortality*
  • Diabetes Mellitus, Type 1 / pathology*
  • Diabetic Angiopathies / mortality*
  • Female
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Male
  • Sex Characteristics*