Self-management Experiences Among Men and Women With Type 2 Diabetes Mellitus

A Qualitative Analysis

Rebecca Mathew; Enza Gucciardi; Margaret De Melo; Paula Barata

Disclosures

BMC Fam Pract. 2012;13(122) 

In This Article

Background

In 2008, an estimated 1.6 million Canadians had clinically diagnosed diabetes mellitus (DM),[1] representing 5.5% of all women and 6.2% of all men.[2] Diabetes can lead to cardiovascular mortality[3,4] and microvascular complications, such as nephropathy,[5] neuropathy,[6,7] and retinopathy.[8] For instance, Canadians with T2DM were approximately 3 times more likely to be hospitalized with a myocardial infarction or stroke than their counterparts without diabetes[9] and are twice as likely to die prematurely compared to those without diabetes.[10] The literature also supports sex differences with respect to morbidity and mortality: women with T2DM have a greater risk of death from cardiovascular disease[11] and stroke[4] compared to men. These differences in mortality may be linked to variations in how men and women experience and manage their diabetes.[12]

The relevant body of literature reports differences in diabetes management experiences between men and women, particularly in their beliefs, attitudes, fears and concerns about the disease. Women, more often than men, view diabetes as negatively affecting their lives. At diagnosis, more women reported fearing loss of health, diabetes-related morbidity, and early mortality compared to men.[13] For instance, women worry more about both acute and chronic diabetes complications such as hypoglycemia,[14] and chronic complications, like cardiovascular and renal disease.[13] Women also report significantly more depressive symptoms,[15] which can lower their participation in diabetes education and medication compliance.[16] Men are more concerned that diabetes will constrain their lifestyles[14] but believe it is controllable.[17] Men report being more concerned about how diabetes affects their provider role,[18] whereas women worry more about how self-care will hinder their familial responsibilities,[19] and they also tend to sacrifice their dietary regimen for their family's food preferences.[19]

There is also literature demonstrating differences in barriers to self-management of T2DM[20,21] but limited studies examining gender specific differences. For example, Nagelkerk et al. completed a qualitative study in which the most commonly reported barriers among patients with diabetes lack of understanding of the overall plan of care and frustration from inadequate metabolic control and progressive disease despite compliance with the self-care recommendations.[22] A study by Whittemore et al. among women with diabetes demonstrated more positive outcome measures, including metabolic control, diet and diabetes-related distress with increased self-confidence in living with diabetes and positive social supports.[23] This study suggests that barriers to diabetes self-care among women might include lack of self-confidence and inadequate support from their immediate friends and family. Another qualitative study by Cherrington et al. examining barriers and facilitators to diabetes self-care among Latino immigrants found that women's barriers related to inadequate social support at home, especially related to food preparation. On the other hand, the predominant barriers to self-care faced by men were lack of flexibility and schedule intensity within the work place.[24] Despite some literature describing these gender differences, there is still a gap in comprehensive narrative accounts of the management experiences of men and women living with diabetes. A better understanding of how diabetes self-management experiences are similar or different between men and women can provide insight to better direct strategies to enhance care and management support to those living with diabetes.

Therefore, the objective of our study is to explore diabetes management experiences, specifically needs, challenges, and barriers identified by men and women using qualitative research methods. This methodology will allow us to understand issues and life experiences that are meaningful and significant to those living with diabetes. Our intention is to build upon the body of evidence to better develop a gender-sensitive understanding of diabetes self-management and discover ways to better integrate gender-specific care into current interventions and clinical practice.

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