Rachel G. Miller, PhD, University of Pittsburgh
Published in Diabetes Care®, February 2025

Women with type 1 diabetes have a greater excess risk for heart disease than their male counterparts, despite having generally lower blood pressure throughout their lives. Dr. Miller aims to understand this discrepancy by combing for clues in the Pittsburgh Epidemiology of Diabetes Complications Study. This study has tracked the health outcomes of people with childhood-onset type 1 diabetes since the 1980s, which provides extensive and rich observational data for Dr. Miller and her colleagues to leverage. 

She and her team are studying how patterns of risk factors beyond blood glucose (blood sugar) differ for men and women with type 1 diabetes across their lifespan, and how these differences affect heart disease and other diabetes complications. Their work revealed that women with type 1 diabetes experience a significant drop in diastolic blood pressure as early as their 20s, decades sooner than the decline that naturally comes with reaching menopause. Also, the effect of blood pressure on cardiovascular disease shows up differently between the sexes: Men with type 1 diabetes and higher blood pressure were more prone to major events like heart attack and stroke, while women with higher blood pressure were more likely to experience coronary artery disease.

The research suggests that the arteries of women with type 1 diabetes may stiffen at far younger ages than expected, offsetting any cardiovascular protection imparted by lower blood pressure. More research is needed to better understand the physiological effects of diabetes on the cardiovascular system, whether pregnancy and menopause affect a woman’s risk of cardiovascular complications from diabetes, and the effectiveness of blood pressure medications. 

Dr. Miller’s findings indicate that blood pressure targets and other cardiovascular risk factors may need to be tailored by sex and life stage. “The ultimate goal would be to move past the current one-size-fits-all approach and hopefully better predict and prevent complications in everyone with diabetes,” she said.

Dr. Miller has studied diabetes for more than 20 years and credits her first ADA grant with “springboarding” her independent research. This work took on new meaning in 2021, when her own 10-year-old daughter was diagnosed with type 1 diabetes. “I went from having this intellectual textbook understanding of what living with diabetes is like to actually helping someone manage it every day,” she shared. “It’s made me a better researcher.”