“These findings are important because they show that women with diabetes are not getting the recommended well-woman care, which is essential to both managing their diabetes and their overall health,” says senior author Lauren Wisk, PhD, an associate professor of medicine at UCLA Health in California.
When those services — including cancer screenings and counseling about birth control and family planning — fall through the cracks, the effects may not be obvious right away. But over time, these missed opportunities can increase the risk of preventable complications, from delayed cancer diagnoses to higher-risk pregnancies that could have negative outcomes for both mom and baby, says Dr. Wisk.
Diabetes Care May Overshadow Important Preventive Health Conversations
To explore how having diabetes affects women’s healthcare, researchers conducted a meta-analysis that combined the findings of many studies to determine common patterns. The meta-analysis included 44 studies of women between the ages of 15 and 49 who had type 1 or type 2 diabetes.
Specifically, researchers compared how often women with diabetes received key preventive aspects of care, compared to women without it.
The data revealed that these women were less likely to receive preventive care in nearly every category. For example, less than half of women with diabetes got birth control counseling, compared to about 62 percent of women without it. They were also 10 to 20 percent less likely to get cervical cancer screening.
Women with diabetes received fertility and prepregnancy counseling at low and inconsistent rates — in some studies, as low as 1 percent. There wasn’t enough data to make a clear comparison to women without diabetes.
Researchers found no studies comparing sexually transmitted infection screening rates, highlighting a major gap in both care and research, wrote the authors.
Taken together, experts say the findings are concerning, even if they’re not entirely unexpected.
“What stood out most is that despite these women having more frequent interactions with the healthcare system, they were still missing out on important preventive care — not just in one area, but across the board,” says Neha Narula, MD, a clinical assistant professor and primary care doctor at the Stanford University School of Medicine in California.
What’s at Stake for Women With Diabetes
“This study doesn’t highlight a small care gap — it has real consequences for women’s health, with high-stakes downstream complications,” says Dr. Narula, who wasn’t involved in the study.
For women with diabetes who are planning to get pregnant, taking steps to be as healthy as possible is important for prenatal and postpartum outcomes, says Marilyn Tan, MD, an endocrinologist at Stanford Health Care in California, who wasn’t involved in the latest study.
Similarly, getting the recommended cancer screenings for diseases such as breast or cervical cancer also helps with early detection, timely treatment, and decreased risk of mortality, says Narula.
“The key point is that these are preventable risks,” she says.
Why These Gaps May Be Happening
The fragmented U.S. healthcare system may be partly to blame, says Wisk.
“We’re not especially good at care coordination. If one provider is focused on diabetes, someone else needs to be making sure preventive care is happening — and that doesn’t always occur,” she says.
In practice, many women with diabetes use their endocrinologist as their primary care doctor, but those visits are typically focused on blood sugar, medications, and related conditions, says Dr. Tan. “Most endocrinology offices are not able to or don’t routinely provide contraception counseling or age-appropriate cancer screening,” she says.
Finally, some of these gaps may also reflect deeper disparities in access to care. The researchers note that groups at higher risk of diabetes — including younger adults, people with lower incomes, and many racial and ethnic minority populations — may also face more barriers to routine preventive services.
The Findings Have Some Limitations
Many of the studies included in the analysis were small or conducted in a single setting, and some relied on patient recall, which introduces the possibility of errors.
The findings show associations but cannot explain exactly why these care gaps exist. Future research should focus on improving care coordination and identifying when women are missing these preventive services, says Wisk.
How Women With Diabetes Can Advocate for Their Care
These findings are a good reminder that all people need preventive care, regardless of their medical issues, says Neha Vyas, MD, an assistant clinical professor and primary care physician at Cleveland Clinic in Ohio.
“This is why it’s so important to have a primary care doctor. Our bread and butter is prevention and preventive services,” says Dr. Vyas, who wasn’t involved in the study.
Narula says that women with diabetes can take a more active role in making sure their preventive care isn’t overlooked. She suggests the following:
- Ask specific questions about family planning and age-appropriate screenings.
- Stay informed about which preventive services you should be getting.
- Work with a trusted provider to keep track of what’s due.
- Consider scheduling a separate wellness visit, especially for family planning and preventive care.
“Preventive care is essential and should not be a secondary priority to chronic conditions such as diabetes,” says Narula.