Health Care Disparities Between Men and Women With Type 2 Diabetes

Marady Sabiaga Mesa, MPH

Disclosures

Prev Chronic Dis. 2018;15(4):e46 

In This Article

Abstract and Introduction

Abstract

Introduction Regular medical checkups indicate a patient's level of adherence to health care treatment, and the frequency of cancelled appointments or no-shows can indicate adherence. This study investigated the use of health care services by men and women and its impact on the control of their type 2 diabetes.

Methods This study observed 100 patients with type 2 diabetes aged 45 years or older who lived in Ventura County, California, during January 1, 2015, to January 31, 2016. The data were collected by Magnolia Family Medical Center. A Pearson χ 2 test compared differences between men and women in whether they received a glycated hemoglobin A1c (HbA1c) test in previous 6 months, a low-density lipoprotein cholesterol test in previous year, and a retinal examination in previous year. A Wilcoxon signed-rank test compared attendance to medical appointments and HbA1c values for men and women.

Results Women had a higher rate of scheduling, cancelling or rescheduling, and showing up to their medical appointments than did men, and men had a higher median HbA1c value than did women; all the Wilcoxon signed-rank tests showed a significant difference (P < .001). None of the χ 2 tests were significant.

Conclusion Although men and women had similar health care services for diabetes, men had less control of their disease and took less advantage of medical appointments than did women.

Introduction

The prevalence of type 2 diabetes increased from 1980 through 2014.[1] Dieting, exercising, attending regular medical check-ups, and screenings may prevent or control such disease.[2] Regular medical checkups indicate a patient's level of adherence to health care treatment, and the frequency of cancelled appointments or no-shows can indicate adherence. Several screenings, such as retinal examinations and laboratory work for glycated hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL) cholesterol, are recommended for proper diabetes care and disease prevention.[3]

HbA1c measurements are used to observe the patient's blood glucose level. The higher the HbA1c, the more sugar is found attached to the red blood cells; HbA1c should be less than 5.7%.[3] People with diabetes have an HbA1c of 6.5% or higher.[3] LDL cholesterol is a measurement of low-density lipid to determine the risk of developing heart disease. Patients are at a higher risk of heart diseases if they have diabetes and have high levels of LDL cholesterol.[3] A retinal examination, or a funduscopy, checks for eye diseases. Uncontrolled diabetes can lead to diabetic retinopathy.[3] According to American Diabetes Association's Standards of Medical Care in Diabetes, HbA1c measurements should be done at least once every 6 months, LDL cholesterol measurements should be done at least once every 5 years, and retinal examinations should be done at least once every 2 years.[3] If patients are taking statins to lower blood pressure, the frequency of LDL cholesterol measurements depends on the physician and patient.[3] Patients with any levels of diabetic retinopathy should have retinal examinations at least once every year.[3]

Proper treatments are done after an individual has had diabetes diagnosed. Preventing or slowing the progression of such disease depends ultimately on the patient. This is a health issue because a disease can progress without early detection, proper diagnosis, treatment, and full commitment of the patient.

Several factors in a person's life can create difficulties in diabetes prevention and control, including the level of adherence to recommended schedules of medical care services. Shalev et al and Krämer et al have found significant difference between men and women and their use of medical care.[4,5] However, both studies were generalizable to individuals outside of the United States. Vaidya et al found that women used preventive care more frequently;[6] however, they did not observe patients already diagnosed with diabetes. Bertakis et al found that women used health care services more often than did men.[7] However, that study examined data on all health care services, including those that may not pertain to men.

The objective of my study was to determine whether differences exist between men and women in the control of diabetes and the use of medical appointments.

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