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Introduction: Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)., Research Design and Methods: GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017., Results: Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m 2 ), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes., Conclusions: This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women., Trial Registration Number: ClinicalTrials.gov (NCT01794143)., Competing Interests: Competing interests: JBG reports grants from NIDDK during the conduct of the study; and grants and personal fees from Boehringer Ingelheim/Lilly, personal fees from NovoNordisk, grants from Roche, personal fees from Hawthorne Effect/Omada, grants and personal fees from Sanofi/Lexicon, personal fees from Pfizer, grants from Glaxo SmithKline, personal fees from Bayer, grants from Merck, and grants and personal fees from AstraZeneca outside the submitted work. HA reports other from Novo Nordisk during the conduct of the study; and other from Novo Nordisk outside the submitted work. CD reports grants and personal fees from Novo Nordisk, personal fees from Astra Zeneca, grants from Sanofi, grants from the Department of Defense, and consultation for Bayer outside the submitted work. AJA reports personal fees from Novo Nordisk and personal fees from Lilly during the conduct of the study; and personal fees from Medtronic outside the submitted work. DJW reports other from Novo Nordisk outside the submitted work. VRA reports grants and other from Applied Therapeutics, grants and other from Fractyl, grants and other from Novo Nordisk, other from Pfizer, grants and other from Sanofi, other from Eli Lilly, and other from Janssen (Spouse) outside the submitted work. BIG, NMB, JHL, TH, HK-S and CES have nothing to disclose., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)