Type 2 diabetes among women: clinical considerations for pharmacological management to achieve glycemic control and reduce cardiovascular risk.

The purpose of this paper is to highlight specific considerations in the medical management of women with type 2 diabetes mellitus (T2DM). T2DM, a significant source of morbidity and mortality, has become an ever growing epidemic within the United States. Although it is well understood that diabetes can significantly increase the risk for microvascular and macrovascular complications, there has been limited research examining the differential impact of these complications on men and women. Women, in particular, are subject to especially high risk for the development of myocardial infarction (MI), claudication, and stroke and are disproportionately afflicted by cardiovascular, cerebrovascular, and peripheral vascular disease. There is new evidence that tight glycemic control and earlier initiation of insulin therapy can improve outcomes and thereby reduce the risk for development of both macrovascular and microvascular complications of the disease. Although there are many commonalities in the treatment of men and women, women with diabetes have several unique issues, including the possible effects of therapy on reproductive health, fetal health, breastfeeding, potential interactions with hormonal contraceptives, and effects on bone health, that should be considered when determining a therapeutic approach. This paper presents evidence-based treatment strategies for reducing the risk of diabetes-associated complications overall and cardiovascular disease in particular through glycemic control. Special attention is paid to the selection of antidiabetic agents that are best suited to the unique needs of women.