Abstract
BackgroundNew approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM.MethodsClinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators.ResultsOverall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached HbA1c levels < =7.0% (23.2% vs. 27.8%; p = 0.03), LDL-cholesterol < 100 mg/dl (48.3 vs. 57.8%; p = 0.0005), and BMI <27 Kg/m2 (27.2 vs. 31.6%; p = 0.04) than men. Women had statistically significant poorer scores for physical functioning, psychological well-being, self-care activities dedicated to physical activities, empowerment, diabetes-related distress, satisfaction with treatment, barriers to medication taking, satisfaction with access to chronic care and healthcare communication, and perceived social support than men; 24.8% of women and 8.8% of men had WHO-5 < =28 (likely depression) (p < 0.0001); 67.7% of women and 55.1% of men had PAID-5 > 40 (high levels of diabetes-related distress) (p < 0.0001). At multivariate analysis, factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women, e.g. having PAID-5 levels >40 was associated with a higher likelihood of HbA1c ≥8.0% in women (OR = 1.15; 95%CI 1.05–1.25) but not in men (OR = 1.00; 95%CI 0.93–1.08).ConclusionsIn T2DM, women show poorer clinical and person-centered outcomes indicators than men. Diabetes-related distress plays a role as a correlate of metabolic control in women but not in men. The study provides new information about the interplay between clinical and person-centered indicators in men and women which may guide further improvements in diabetes education and support programs.
Highlights
New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors
The analysis was important to demonstrate that gender disparities are less pronounced in Italy than in other countries, but that the likelihood to reach specific clinical outcomes is systematically unfavorable for women as compared to men; in particular, women were 14% more likely than men to have HbA1c levels >9.0% in spite of insulin treatment, 42% more likely to have LDL-cholesterol ≥130 mg/dl in spite of lipid-lowering treatment, and 50% more likely to have body mass index (BMI) ≥30 Kg/m2
These findings suggested that a complex interplay among biological, clinical and behavioral differences can underlie these differences and call for diversifying the care and specializing the support provided to men and women
Summary
New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. The analysis was important to demonstrate that gender disparities are less pronounced in Italy than in other countries, but that the likelihood to reach specific clinical outcomes is systematically unfavorable for women as compared to men; in particular, women were 14% more likely than men to have HbA1c levels >9.0% in spite of insulin treatment, 42% more likely to have LDL-cholesterol ≥130 mg/dl in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 Kg/m2 These findings suggested that a complex interplay among biological, clinical and behavioral differences can underlie these differences and call for diversifying the care and specializing the support provided to men and women
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