Social stigma related to lesbian and bisexual women’s sexual orientation is believed to underlie a number of observed health disparities in this patient population, including preventable differences in the burden of disease and opportunities to achieve optimal health experienced by socially disadvantaged populations. It has been hypothesized that lesbian and bisexual women may be at elevated risk for developing type 2 diabetes, when compared with heterosexual women, due to a greater likelihood of risk factors such as obesity, tobacco smoking, and stress-related exposures like discrimination, violence victimization, and psychological distress. However, studies to determine whether lesbian and bisexual women experience disparities in developing type 2 diabetes have been hampered by methodologic limitations—including cross-sectional designs and low statistical power—and have provided inconclusive results.

To bring greater clarity to this area of research, my colleagues and I analyzed longitudinal data from over 94,000 women participating in the Nurses’ Health Study II and published our findings in Diabetes Care. Participants aged 24 to 68 across the study period were followed from 1989 to 2013 to track their incidence of type 2 diabetes through biennial follow-up questionnaires. During follow up, lesbian and bisexual women had a 27% higher incidence rate of type 2 diabetes than did heterosexual women. When participants were aged 24 to 39 years old, lesbian and bisexual women had more than twice the risk of developing type 2 diabetes, suggesting that lesbian and bisexual women live with the burden of type 2 diabetes for a longer duration of their life. However, a lack of research on management of type 2 diabetes among lesbian and bisexual women makes it difficult to draw strong conclusions.

Findings from our study indicate that healthcare professionals should be aware that lesbian and bisexual women have health disparities, including chronic diseases like type 2 diabetes. Existing research indicates that dietary intake and physical activity do not appreciably differ among lesbian, bisexual, and heterosexual women, and thus cannot explain these disparities. However, the higher rates of tobacco smoking, stress, and obesity—important contributors to chronic disease—may help explain the differences seen in our study.

We recommend that healthcare professionals and organizations receive training and education on optimal strategies for serving this patient population. Information on educational programs, resources, and consultation to optimize quality, cost-effective healthcare for lesbian and bisexual women is available through the National LGBT Health Education Center at lgbthealtheducation.org.

References

Corliss H, VanKim N, Jun H, et al. Risk of Type 2 Diabetes Among Lesbian, Bisexual, and Heterosexual Women. Diabetes Care. 2018;41(7):1448-1454. Available at
http://care.diabetesjournals.org/content/41/7/1448.