Living with diabetes is not easy. From food restrictions to health complications—this ailment brings along a plethora of challenges into the life of a patient. Turns out, the life of a diabetic woman is a whole lot more complicated than that of a diabetic man.

Why you ask? Well, a global study of 12 million people has found that women with diabetes are at a greater risk of heart failure than men.

According to the International Diabetes Federation (IDF), currently 415 million adults worldwide live with diabetes–with approximately 199 million of them being women.

In India, which is often called the diabetes capital of the world, there were over 72 million cases of diabetes in 2017 alone, which means about 8.8% of the country’s adult population had the disease.

While type-1 diabetes is associated with a 47% excess risk of heart failure in women as compared to men, type-2 diabetes has a nine per cent higher excess risk of heart failure for women than men, said the study published in the journal Diabetologia.

There are a number of reasons why women with diabetes are at a greater risk of heart complications, said study co-author Sanne Peters of The George Institute for Global Health at the University of Oxford.

“Women were reported to have two years’ longer duration of prediabetes than men and this increased duration may be associated with greater excess risk of heart failure in women” said Peters.

“Some major concerns are that women are also being undertreated for diabetes, are not taking the same levels of medications as men and are less likely to receive intensive care,” Peters said.

The IDF reports that girls and women with diabetes experience a range of challenges. Gender roles, power imbalances, socioeconomic inequalities resulting in poor diet and lack of physical activity can all influence vulnerability to diabetes.

Women’s limited access to health services and lack of pro-activity when it comes to seeking treatment for health problems can also amplify the impact of diabetes, particularly in developing countries.

The IDF expects by the year 2040 around 313 million women will be suffering from the disease.

Diabetes is the ninth leading cause of death in women and claims 2.1 million female lives every year, more so than men. The number one leading cause of death for women is heart disease.