Sex Differences in Multifactorial Target Attainment in Type 2 Diabetes: A Primary Care Cohort of 40,211 Adults (PROMETEA)

Background To identify sex-specific, actionable gaps in metabolic control and multifactorial target attainment in adults with type 2 diabetes Methods Cross-sectional analysis of 40,211 adults with type 2 diabetes from a primary care registry (46,3% women). Outcomes were HbA1c, LDL-cholesterol (LDL-C), systolic/diastolic blood pressure (SBP/DBP), body mass index (BMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR). Targets were HbA1c < 7%, LDL-C < 100 mg/dL, BP < 140/90 mmHg, and a composite triple target. Sex differences were assessed with multivariable linear regression (HbA1c) and robust Poisson regression (target attainment), adjusted for age, diabetes duration, and BMI, and including sex-by-age and sex-by-duration interaction terms. Results Women were older than men (73.9 ± 11.7 vs 70.2 ± 11.3 years) and had higher mean LDL-C (103.0 ± 32.8 vs 95.7 ± 32.4 mg/dL) and BMI (31.1 ± 6.9 vs 30.3 ± 6.6 kg/m²) (all p < 0.001). Female sex was independently associated with higher HbA1c (adjusted β + 0.075, 95% CI + 0.050 to + 0.100; p < 0.001), and the sex gap in HbA1c widened at older ages and longer diabetes duration (both interaction p < 0.001). Men more frequently had albuminuria (UACR ≥ 30 mg/g: 24.5% vs 17.3%), whereas women more often had reduced renal function (eGFR < 60 mL/min/1.73 m²: 24.9% vs 17.3%) (both p < 0.001). Overall, only 17.9% achieved the triple target (men 19.5% vs women 16.2%, p < 0.001). Compared with women, men were 3% more likely to achieve the HbA1c target (adjusted prevalence ratio (aPR) 1.03, 95% CI 1.01–1.04), 22% more likely to reach the LDL-C target (aPR 1.22, 1.20–1.24), and 21% more likely to attain the composite triple target (aPR 1.21, 1.16–1.26), but 4% less likely to achieve the BP target (aPR 0.96, 0.95–0.98). Equalizing women’s composite attainment to men’s would translate into ≈ 614 additional women meeting all three targets. Conclusions In contemporary primary care,women with type 2 diabetes have consistent shortfalls in LDL-C control and composite multifactorial target attainment, and their glycemic disadvantage increases with age and longer diabetes duration. These actionable patterns support sex-aware implementation strategies—prioritizing lipid-lowering optimization in women across ages and tailoring glycemic intensification for older and long-duration women—to close treatment gaps and improve risk factor control.