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

Abstract

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.

Adesão ao tratamento do diabetes mellitus e variáveis sociodemográficas, clinicas e de controle metabólico

“…(19,20) On the other hand, patients with a longer length of diagnosis may have further information on the disease, making them feel safer and more self-confident towards the proposed treatment. (21) Over time, treatment compliance can be neglected due to a lack of motivation and perception of effective results, lack of time, absence of family support, comorbidities, cultural issues, among others.…”

Prediction of therapy response in acromegalic patients under pegvisomant therapy within the German ACROSTUDY cohort

“…It has been shown that these subjective and psychological measures such as quality of life and symptom scores were the most important indicators for predicting various hard outcomes such as survival times, mortality, hospital readmission, therapy success or biochemical control after adjusting for known clinical factors in cancer patients, in patients with chronic diseases such as diabetes mellitus or heart failure and in the general population [15][16][17][18][19].…”

“…In fact, pre-treatment subjective quality of life data may be the most reliable factor for guiding physicians to establish prognostic criteria for patients' therapy outcome [15,19].…”

Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence

“…The assessment of coping styles, in addition to distress, was conducted because of their central role in the human stress process, and specifically their influence on the individual's emotional reactions to demanding/stressful experiences, including disease [13]. Indeed, in diabetes, the interaction between coping style and psychological distress has been shown to influence glycaemic control [14][15][16]. Our secondary aims included: (1) an examination of the effects of distress and coping style on an additional healing outcome, i.e.…”