Gender-specific care of the patient with diabetes: Review and recommendations

Legato, Marianne J.; Gelzer, Andrea; Goland, Robin; Ebner, Susana A.; Rajan, Sabitha; Villagra, Victor G.; Kosowski, Mark

doi:10.1016/s1550-8579(06)80202-0

Cited by 208 publications

(178 citation statements)

References 168 publications

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“…Previous studies have found worse BP control, higher SBP [22] and higher LDLcholesterol in women patients [26]. It has therefore been suggested that women might be receiving lower-quality treatment [27], possibly contributing to their excess cardiovascular morbidity and mortality rates [3,28]. However, we detected only minor, clinically irrelevant changes in cardiovascular risk factors and no differences in diabetes-related complications between men and women.…”

Section: Discussioncontrasting

confidence: 51%

Sex-related psychological effects on metabolic control in type 2 diabetes mellitus

et al. 2009

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Aims/hypothesis Women are at higher risk of diabetesrelated cardiovascular complications than men. We tested the hypothesis that there are sex-specific differences in glucometabolic control, and in social and psychological factors. We also examined the influence of these factors on glucometabolic control. Methods We examined 257 (126 men/131 women) consecutive patients (64±9 years, means±SD) of a metropolitan diabetes outpatient service employing clinical testing and standardised psychological questionnaires. Results Mean HbA 1c (7.6±1.2%) was not different between women and men. Women patients on oral hypoglycaemic agents were better informed about diabetes (p=0.012). They employed more strategies for coping with diabetes, including religion (p=0.0001), active coping (p=0.048) and distraction (p=0.007). Women reported lower satisfaction with social support (p=0.034), but not more depression than men. Although no differences were observed in compliance, insulin-treated patients were more satisfied with their therapy (p=0.007). Variables predicting poor metabolic control were different in men (R 2 =0.737, p=0.012) and women (R 2 =0.597, p=0.019). Major predictors of high HbA 1c included depressive coping, lower sexual desire, quality of life and internal locus of control, but high external doctor-related locus of control in women and frequent emotional experiences of hyperglycaemia in men. Conclusions/interpretation Lower quality of life, internal control and socioeconomic status, and higher prevalence of negative emotions probably prevented woman patients from achieving improved glucose control despite their better knowledge of and greater efforts to cope with diabetes. We suggest that women patients would benefit from individualised diabetes care offering social support, whereas men would benefit from knowledge-based diabetes management giving them more informational and instrumental support.

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Section: Discussioncontrasting

confidence: 51%

Sex-related psychological effects on metabolic control in type 2 diabetes mellitus

et al. 2009

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“…Female sex during adolescence has been shown to exert a positive influence on insulin sensitivity, lipids and blood pressure (Moran et al 2008), which is in line with the notion that premenopausal women have a lower risk of developing the metabolic syndrome compared with age-matched men (Isomaa et al 2001, Legato et al 2006, Regitz-Zagrosek et al 2007. No single risk factor or combination of factors has yet been shown to fully explain this, but the fact that risk protection disappears after menopause strongly suggests that female hormones play a protective role.…”

Section: Introductionsupporting

confidence: 56%

Sex-dependent hepatic transcripts and metabolites in the development of glucose intolerance and insulin resistance in Zucker diabetic fatty rats

Gustavsson

Soga²,

Wahlström

et al. 2011

Journal of Molecular Endocrinology

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Male Zucker diabetic fatty (mZDF) rats spontaneously develop type 2 diabetes, whereas females only become diabetic when fed a diabetogenic high-fat diet (high-fat-fed female ZDF rat, HF-fZDF). The aim of this study was to investigate if differences in liver functions could provide clues to this sex difference. Non-diabetic obese fZDF rats were compared with either mZDF or HF-fZDF regarding hepatic molecular profiles, to single out those components that might be protective in the females. High-fat feeding in fZDF led to enhanced weight gain, increased blood glucose and insulin levels, reduced insulin sensitivity and a trend towards reduced glucose tolerance, indicative of a prediabetic state. mZDF rats were diabetic, with low levels of insulin, high levels of glucose, reduced insulin sensitivity and impaired glucose tolerance. Transcript profiling and capillary electrophoresis time-of-flight mass spectrometry were used to indentify hepatic transcripts and metabolites that might be related to this. Many diet-induced alterations in transcript and metabolite levels in female rats were towards a 'male-like' phenotype, including reduced lipogenesis, increased fatty acid (FA) oxidation and increased oxidative stress responses. Alterations detected at the level of hepatic metabolites, indicated lower capacity for glutathione (GSH) production in male rats, and higher GSH turnover in females. Taken together, this could be interpreted as if anabolic pathways involving lipogenesis and lipid output might limit the degree of FA oxidation and oxidative stress in female rats. Together with a greater capacity to produce GSH, these hepatic sex differences might contribute to the sex-different development of diabetes in ZDF rats.

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“…Since 1994, the NIH has also required analyses of trial outcomes by sex. Nevertheless, even if scientific journals are more aware of sex/gender nowadays, there are still many recommendations about treatments and drugs that are based on studies where the majority of participants were men [33][34][35][36][37]. It is equally common that no sex-based analyses are performed even though both men and women are enrolled, or that too few women (or men) were included to allow for sex-based analyses.…”

Section: Gender Blindness In Researchmentioning

confidence: 99%

Gender Bias in Medicine

Hamberg

2008

Womens Health (Lond Engl)

243

146

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Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research. Research has shown that different biological processes, anatomies, conditions in daily life, environmental experiences, risk behaviors and responses to stressful events, may all contribute to variation in health and disease in men and women [1-5]. There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6-11]. The word bias means 'prejudice' or 'distortion' and is a threatening phenomenon in all kinds of research and human activity. When we talk about gender bias in medicine we usually either mean an unintended, but systematic neglect of either women or men, stereotyped preconceptions about the health, behavior, experiences, needs, wishes and so on, of men and women, or neglect of gender issues relevant to the topic of interest. Gender bias has implications in treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender bias is also a relevant issue in the discussion of clinical and academic advancements and careers [12]; however, that aspect is not the focus of this article. Since there is confusion in medicine about the use of the concept of gender [13], my use of the term is presented below.

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Gender-specific care of the patient with diabetes: Review and recommendations

Cited by 208 publications

References 168 publications

Sex-related psychological effects on metabolic control in type 2 diabetes mellitus

Sex-related psychological effects on metabolic control in type 2 diabetes mellitus

Sex-dependent hepatic transcripts and metabolites in the development of glucose intolerance and insulin resistance in Zucker diabetic fatty rats

Gender Bias in Medicine

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