Gender Differences in Diabetes Technology: Adherence and Outcomes — A Systematic Review

Diabetes management technologies — including continuous glucose monitors (CGM), insulin pumps (CSII), advanced hybrid closed-loop (AHCL) systems, and mobile health applications — have transformed diabetes care, yet gender-specific differences in adherence, clinical outcomes, and patient-reported outcomes remain inadequately characterised. We conducted a systematic literature review following PRISMA 2020 guidelines, searching SciSpace, Google Scholar, and PubMed databases. From 852 identified records, 500 underwent title/abstract screening after duplicate removal; 16 studies were ultimately included in the qualitative synthesis. Included studies examined insulin pumps (n=7), CGM (n=6), AHCL systems (n=4), remote monitoring programmes (n=2), and mobile health applications (n=1); sample sizes ranged from 72 to 22,697 participants. Females demonstrated higher insulin pump discontinuation rates (discontinuation groups: 75% vs. 46%, p=0.001), driven by body image concerns and device visibility, whereas males showed poorer adherence to intermittently scanned CGM (approximately 4 fewer scans/day, p=0.011). Glycaemic outcomes were modestly but consistently different: males achieved slightly higher time-in-range while females exhibited lower glycaemic variability; menstrual-cycle effects on glycaemic control were partially mitigated by AHCL systems. Females consistently reported greater diabetes-related distress and a more negative perception of glycaemic control despite similar or better objective metrics. In conclusion, substantial gender disparities exist across technology type, adherence, glycaemic control, and psychosocial outcomes; gender-sensitive prescription, education, and technology design are warranted.