What do we know about drug functioning according to gender? The results of a survey among Italian diabetologists

Drugs have different efficacy and toxicity profiles, according to gender. The ‘sexome’ reflects the sum of sex-based effects on gene networks and cell systems and leads to the main pharmacokinetic and pharmacodynamic differences between sexes, with more side effects and lower dose requirement in women. Starting from 2014, it was strongly recommended designing clinical trials equally involving both sexes/genders, since male participation has always been prevalent up to now. The aim of this survey was to explore the level of Italian diabetologists’ awareness and knowledge of sex-related metabolism and effects of drugs, frequently used in treatment and prevention of diabetes and its complications. Considering the historical period, in-depth study on Sars- CoV-2 vaccines was also included. The survey, consisting of fifteen multiple-choice questions, was sent to AMD members (Associazione Medici Diabetologi) from the 1st of May to the end of June 2022. A hundred and twenty-eight diabetologists, working in the territory clinics and hospitals of the National Health System located throughout Italy, replied to the survey. The survey results indicate that the greatest uncertainty was related to the use of ‘cardiovascular’ drugs, such as spironolactone and anti-hypertensive drugs, while the best knowledge was observed for antidiabetic agents, particularly metformin. Little is known about the effects of the Sars-CoV-2 vaccines in the two genders. Despite the limitations of the study due to the small sample size (128 participants, approximately 10% of AMD subscribers), the ‘gender and drugs’ survey highlighted both the need to train diabetologists on the different sex-based response to drugs, and the importance of designing studies that focus on sex disparities in dosage, efficacy and side effects, thus promoting gender equality in health care.