Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA1c

Abstract

OBJECTIVE -Diabetic men and women differ in lifestyle and attitudes toward diabetes and may benefit differently from interventions to improve glycemic control. We explored the relation between HbA 1c (A1C), sex, treatment allocation, and their interactions with behavioral and attitudinal characteristics in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -Six years after their diabetes diagnosis, a population-based sample of 874 primary care patients cluster-randomized to receive structured personal care or routine care reported lifestyle, medication, social support, diabetes-related consultations, and attitudes toward diabetes. Multivariate analyses were applied, split by sex.RESULTS -A marked intervention effect on A1C was confined to the structured personal care women. The median A1C was 8.4% in structured personal care women and 9.2% in routine care women (P Ͻ 0.0001) and 8.5% in structured personal care men and 8.9% in routine care men (P ϭ 0.052). Routine care women had a 1.10 times higher A1C than structured personal care women, (P Ͻ 0.0001, adjusted analysis). Structured personal care women had relatively more consultations than routine care women, but neither number of consultations nor other covariates helped to explain the sex difference in A1C. Irrespective of treatment allocation, women had more adaptive attitudes toward diabetes but lacked support compared with men.CONCLUSIONS -In this study, the observed effect of structured personal care on A1C was present only among women, possibly because they were more inclined to comply with regular follow-up and had a tendency to have a more adaptive attitude toward diabetes. Diabetes Care 29:963-969, 2006

Self Care Activities, Diabetic Distress and other Factors which Affected the Glycaemic Control in a Tertiary Care Teaching Hospital in South India

“…The literature shows a mixed opinion on the gender determined glycaemic control in type 2 diabetes. Some reports [11,12] showed a gender inequality, while others [13,14] have indicated no difference between males and females.…”

The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

“…Women find it more stressful to accommodate their own needs and health concerns into daily life since they often see themselves as caretakers and givers rather than receivers [33]. We previously reported a more adaptive attitude towards treatment among women, and this could lead to better treatment adherence and disease outcomes [13]. Women report poorer social support compared with men [34], possibly linked to a poorer self-perceived quality of life [35].…”

“…Women accept disease and implement disease management more easily [13], which might affect long-term outcomes. Masculinity may be challenged by diabetes, demanding daily consideration and lifestyle changes [34].…”

“…Genderbased behaviour change and attitudes towards diabetes are common observations. Women tend to diet more [8][9][10], use the healthcare system more often [11] and more often report that diabetes has a negative impact on their lives [12], but they exercise less than men [9,10,13]. Despite these known gender differences in diabetes-related behaviour and diabetes outcomes there is only limited evidence on the impact of gender on the effectiveness of diabetes interventions.…”

“…NCT01074762), the intervention of structured personal care reduced the incidence of any diabetes-related outcome and myocardial infarction (MI) in patients newly diagnosed with type 2 diabetes [15]. However, the observed effect of structured personal care on reducing HbA 1c measured 6 years after diagnosis was present only in women [13]. With evidence of gender differences in disease outcomes, behaviours and attitudes in people with type 2 diabetes, it is relevant to investigate the impact of gender on intervention outcomes in diabetes trials.…”