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

Background: 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. Objective: To identify sociodemographic factors associated with poor metabolic control among patients with T2DM at a public outpatient clinic in Quito, Ecuador. Methods: 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. Results: 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. Conclusions: 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.