Background <p>More than 80&#xa0;million South Asians are living with type 2 diabetes (T2D). Despite increasing recognition that gender contributes to the prevention, treatment and outcomes of diseases, studies on gender and diabetes are scarce globally and particularly in impoverished and typically patriarchal settings, where gender hierarchies might be more pronounced. We explored how differences in gender roles, gendered access to, and control over resources, and social norms contribute to gender differences in treatment and management of T2D in an urban slum of Bangladesh.</p> Methods <p>Data were collected between January and April, 2021 from Bauniabadh slum in Dhaka city, Bangladesh using 8 Key Informant Interviews (KII) and 60 In-Depth Interviews (IDI), with equal numbers of women and men aged 35 years or more, and a confirmed diagnosis of T2D at least two years prior to the current study. Within and across gender analyses were performed. We used positive and negative deviance approaches to understand the factors underlying variation in treatment and management of T2D.</p> Results <p>Individual, household and structural factors posed gendered challenges to management of T2D. Compared to men, women were more prone to financial and time constraints originating from rigid gender roles and discriminatory entitlements in the household and society. Women employed more coping strategies than men to deal with financial constraints when seeking medical treatment. Strong household financial status, relevant connections and support from the family underlied high-performance by men in the management of T2D. Household financial status was a necessary, but not sufficient condition for high-performance among women. In addition, women’s economic empowerment, agency, voice and power appear to be key for optimising T2D management.</p> Conclusions <p>The findings highlight the importance of tailored programmes and policies for T2D to reduce gender inequities T2D management.</p>