# Addressing gender and social inequities: the challenge of metabolic control in women with type 2 diabetes in Quito

## TL;DR

This study shows that women with type 2 diabetes in Quito, Ecuador, face greater challenges in controlling their metabolic health due to factors like gender, education, and insurance status.

## Contribution

The first study in Ecuador to use an intersectionality framework to analyze diabetes disparities, combining structural and individual factors.

## Key findings

- Women had higher odds of poor HDL-C control and overweight/obesity compared to men.
- Lower education and younger age were linked to worse metabolic outcomes.
- Women of working age with low education and public insurance had the highest rates of poor glycemic and cardiovascular control.

## Abstract

Type 2 diabetes mellitus (T2DM) is increasingly prevalent in low- and middle-income countries. Metabolic control reflects not only clinical care and individual behaviors but also intersecting social determinants such as sex, education, and insurance status.

To identify sociodemographic factors associated with poor metabolic control among patients with T2DM at a public outpatient clinic in Quito, Ecuador.

We conducted a cross-sectional study of adults with T2DM (ICD-10 E10–E14) attending the clinic in the first semester of 2018. Clinical variables included body mass index (BMI), blood pressure, and laboratory results (HbA1c, total cholesterol, HDL-C, LDL-C, triglycerides). Sociodemographic variables were age, sex, education, marital status, and insurance type. Associations with uncontrolled metabolic indicators were examined using bivariate tests and multivariable logistic regression.

A total of 644 patients were included, 53.6% women. Women had significantly higher odds of poor HDL-C control (aOR 1.73; 95% CI 1.26–2.38) and overweight/obesity (aOR 1.96; 95% CI 1.40–2.74) compared with men. No significant sex differences were observed for HbA1c, blood pressure, or LDL-C. Lower education and younger age were also associated with poorer metabolic outcomes.

Metabolic control in this population is shaped by intersecting sociodemographic determinants. These findings highlight the relevance of sex, age, education, and insurance in shaping diabetes outcomes and underscore the value of an intersectional approach for understanding inequities. Equity-oriented strategies that incorporate intersectionality may improve diabetes care in Ecuador. Given the cross-sectional design, findings indicate associations rather than causality.

Main findings: Metabolic control among patients with type 2 diabetes mellitus (T2DM) in an urban Ecuadorian ambulatory clinic is significantly associated with sociodemographic factors, particularly sex, age, educational attainment, and type of health insurance; women of working age with low educational levels and enrolled in general public insurance exhibited the highest rates of poor glycemic and cardiovascular risk control.Added knowledge: This is the first study in Ecuador to apply an intersectionality-informed framework to assess disparities in metabolic control among patients with T2DM. Reveals how combining structural determinants (insurance type) and individual characteristics (sex, age, education) offers a more nuanced understanding of chronic disease management; it advances empirical evidence from Latin America in applying intersectionality to non-communicable disease outcomes, a gap rarely addressed in regional literature.Global health impact for policy and action: This is the first study in Ecuador to apply an intersectionality-informed framework to assess disparities in metabolic control among patients with T2DM. Reveals how combining structural determinants (insurance type) and individual characteristics (sex, age, education) offers a more nuanced understanding of chronic disease management; it advances empirical evidence from Latin America in applying intersectionality to non-communicable disease outcomes, a gap rarely addressed in regional literature.

Main findings: Metabolic control among patients with type 2 diabetes mellitus (T2DM) in an urban Ecuadorian ambulatory clinic is significantly associated with sociodemographic factors, particularly sex, age, educational attainment, and type of health insurance; women of working age with low educational levels and enrolled in general public insurance exhibited the highest rates of poor glycemic and cardiovascular risk control.

Added knowledge: This is the first study in Ecuador to apply an intersectionality-informed framework to assess disparities in metabolic control among patients with T2DM. Reveals how combining structural determinants (insurance type) and individual characteristics (sex, age, education) offers a more nuanced understanding of chronic disease management; it advances empirical evidence from Latin America in applying intersectionality to non-communicable disease outcomes, a gap rarely addressed in regional literature.

Global health impact for policy and action: This is the first study in Ecuador to apply an intersectionality-informed framework to assess disparities in metabolic control among patients with T2DM. Reveals how combining structural determinants (insurance type) and individual characteristics (sex, age, education) offers a more nuanced understanding of chronic disease management; it advances empirical evidence from Latin America in applying intersectionality to non-communicable disease outcomes, a gap rarely addressed in regional literature.