Exploring differences in Canadian adult men and women with Diabetes management: results from the Canadian Community Health Survey

BMC Public Health

Enza Gucciardi¹  Eric de Sa²  Margaret De Melo³ 

[1] School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2 K3, Canada;University Health Network, Toronto, Canada;SunLife Financial Banting and Best Diabetes Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada

关键词: Canadian community health survey;    Health behaviours;    Self-care medical management;    Sex;    Diabetes;   

Others  :  1161538
DOI  :  10.1186/1471-2458-13-1089

 received in 2013-02-17, accepted in 2013-11-04,  发布年份 2013

【 摘 要 】

Background

Over two million Canadians are known to have diabetes. In addition to the economic burden placed on the healthcare system, the human cost associated with diabetes poses a heavy burden on those living with diabetes. The literature shows that apparent differences exist in diabetes complications and diabetes management between men and women. How self-care management and utilization of health services differ by sex is not clearly understood.

The purpose of this study was to explore sex differences in diabetes self-care and medical management in the Canadian population, using a nationally representative sample.

Methods

Data collected from the cross-sectional, population-based Canadian Community Health Survey (2007–2008) were used in these analyses. A bootstrap variance estimation method and bootstrap weights provided by Statistics Canada were used to calculate 95% confidence intervals. Bivariate analyses identified variables of interest between females and males that were used in subsequent multivariate analyses.

Results

A total of 131,959 respondents were surveyed for the years of 2007 and 2008, inclusive. Fully adjusted multinomial and logistic regression analyses revealed sex differences for those living with diabetes. Compared to men with diabetes, women were more likely to be in the lowest income quintiles than the highest (OR: 1.8, 95% CI: 1.3-2.6) and were more likely not to have a job in the previous week (OR: 1.8, 95% CI: 1.4-2.4). Women were also more likely to avoid foods with fats or high calories (OR: 2.1, 95% CI: 1.4-3.0 and OR: 2.2, 95% CI: 1.6-3.0, respectively), to be concerned about heart disease (OR: 1.6, 95% CI: 1.1-2.2), and to be non-smokers (OR: 2.2, 95% CI: 1.6-3.0). However, despite their increased concern, women checked their blood-glucose less frequently on a daily basis than men (μ_women = 1.7, 95% CI: 1.7-1.8; μ_men = 3.1, 95% CI: 2.9-3.2). Women were more likely to have an anxiety disorder (OR: 2.3, 95% CI: 1.7-3.2) and a mood disorder (OR: 2.4, 95% CI: 1.8-3.1), and more likely to be physically inactive (OR: 1.5, 95% CI: 1.2-1.8).

Conclusions

Our findings underscore the importance of addressing sex differences which may interfere with diabetes self-care. In women, addressing socioeconomic and psychological barriers, as well as limitations to active living are important; in men, the benefit of more effective nutrition therapy and smoking cessation interventions are suggested. The results for this study highlight the need to further investigate and eliminate disparities between the sexes in order to optimize health outcomes among Canadians with diabetes.

【 授权许可】

   
2013 De Melo et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Public Health Agency of Canada: National Diabetes Fact Sheets Canada 2008, Diabetes in Canada – Facts and Figures. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf webcite
• [2]Ohinmaa A, Jacobs P, Simpson S, Johnson JA: The projection of prevalence and cost of diabetes in Canada: 2000 to 2016. Can J Diabetes 2004, 28:116-123.
• [3]Canadian Diabetes Association: An Economic Tsunami, the Diabetes Cost of Diabetes in Canada. Toronto, ON: Canadian Diabetes Association; 2009.
• [4]Bertoni AG, Krop JS, Anderson GF, Brancati FL: Diabetes-related morbidity and mortality in a national sample of U.S. elders. Diabetes Care 2002, 25:471-475.
• [5]Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434-444.
• [6]Liao Y, Cooper RS, Ghali JK, Lansky D, Cao G, Lee J: Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease. Diabetes Care 1993, 16(5):708-713.
• [7]Canadian Diabetes Association: The Prevalence and Cost of Diabetes. http://www.diabetes.ca/diabetes-and-you/what/prevalence/ webcite
• [8]Canadian Diabetes Association Clinical Practice Guidelines Expert Committee: Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008, 32:S1-S201.
• [9]Barrett-Connor E, Giardina EG, Gitt AK, Gudat U, Steinberg HO, Tschoepe D: Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med 2004, 164:934-942.
• [10]Zandbergen AA, Sijbrands EJ, Lamberts SW, Bootsma AH: Normotensive women with type 2 diabetes and microalbuminuria are at high risk for macrovascular disease. Diabetes Care 2006, 29:1851-1855.
• [11]Huxley R, Barzi F, Woodward M: Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006, 332:73-78.
• [12]Liao Y, Cooper RS, Ghali JK, Lansky D, Cao G, Lee J: Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease. Diabetes Care 1993, 16:708-713.
• [13]Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen E: Diabetes mellitus as a risk factor for death from stroke. Prospective study of the middle-aged Finnish population. Stroke 1996, 27:210-215.
• [14]Lundberg V, Stegmayr B, Asplund K, et al.: Diabetes as a risk factor for myocardial infarction: population and gender perspectives. J Intern Med 1997, 241:485-492.
• [15]Homko CJ, Zamora L, Santamore WP, Kashem A, McConnel T, Bove AA: Gender differences in cardiovascular risk factors and risk perception among individuals with diabetes. Diabetes Educ 2010, 36(3):483-488.
• [16]Auryan S, Itamar R: Gender-specific care of diabetes mellitus: Particular considerations in the management of diabetic women. Diabetes Obes Metab 2008, 10:1135-1156.
• [17]Booth GL, Lipscombe LL, Bhattacharyya O, Feig DS, Shah BR, Degani N, Johns A, Ko B, Bierman AS: Diabetes. In Project for an Ontario Women’s Health Evidence-Based Report: Volume 2 . Edited by Bierman AS. Toronto: The POWER Study; 2010.
• [18]Canadian Community Health Survey (CCHS): Annual Component User Files, 2007–2008 Microdata Files. Canada: Statistics; 2009.
• [19]Inc SAS: SAS/STAT User’s Guide. Cary, NC: SAS Institute; 1989.
• [20]World Health Organization (WHO): Global Database on Body Mass Index. [http://apps.who.int/bmi/index.jsp?introPage=intro_3.html webcite]
• [21]Statistics Canada: Diabetes, by Age Group And Sex. (Number of Persons). 2010. [http://www40.statcan.gc.ca/l01/cst01/health53a-eng.htm webcite]
• [22]Diabetes Care Gaps and Disparities in Canadians: Canadian Institute for Health Information. 2009. [https://secure.cihi.ca/free_products/phci_infosheet_20100209_e.pdf webcite]
• [23]Tang M, Chen Y, Krewski D: Gender-related differences in the association between socioeconomic status and self-reported diabetes. Intern J Epidemiol 2003, 32:381-385.
• [24]Dasgupta K, Khan K, Ross NA: Type 2 diabetes in Canada: concentration of risk among most disadvantaged men but inverse social gradient across groups in women. Diabet Med 2010, 27:522-531.
• [25]Kavanagh A, Bentley RJ, Turrel G, Shaw J, Dunstan D, Subramanian SV: Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Soc Sci Med 2010, 71(6):1150-1160.
• [26]Saydah S, Lochner K: Socioeconomic status and risk of diabetes-related mortality in the U.S. Pub Health Reports 2010, 125:377-388.
• [27]Barrett-Connor E, Giardina EG, Gitt AK, Gudat U, Steinberg HO, Tschoepe D: Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med 2004, 164(9):934-942.
• [28]Zandbergen AA, Sijbrands EJ, Lamberts SW, Bootsma AH: Normotensive women with type 2 diabetes and microalbuminuria are at high risk for macrovascular disease. Diabetes Care 2006, 29(8):1851-1855.
• [29]Huxley R, Barzi F, Woodward M: Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006, 332(7533):73-78.
• [30]Liao Y, Cooper RS, Ghali JK, Lansky D, Cao G, Lee J: Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease. Diabetes Care 1993, 16(5):708-713.
• [31]Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen E: Diabetes mellitus as a risk factor for death from stroke. Prospective study of the middle-aged Finnish population. Stroke 1996, 27(2):210-215.
• [32]Prasanna Kuma KM: Gender differences in diabetes mellitus. Int J Diab Dev Countries 1996, 16:103-104.
• [33]Pilote L, Dasgupta K, Guru V, Humphries KH, McGrath J, Norris C, et al.: A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ 2007, 176(6):S1-S44.
• [34]The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329:977-986.
• [35]UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837-853.
• [36]Parkin CG, Davidson JA: Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes. J Diabetes Sci Technol 2009, 3:500-508.
• [37]Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV: Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care 2000, 23(4):477-483.
• [38]Boyko EJ, Lipsky BA: Infection and diabetes. In Diabetes in America. 2nd edition. Bethesda, MD: National Diabetes Data Group, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995:485-499. http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter22.pdf webcite
• [39]Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL III, Klein R: Retinopathy in Diabetes. Diabetes Care 2004, 27(Suppl 1):84-87.
• [40]Church TS, Cheng YJ, et al.: Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 2004, 27:83-88.
• [41]Kenny GP, Wasserman DH, et al.: Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006, 29:1433-1438.
• [42]McCollum M, Hansen LB, Lu L, Sullivan PW: Gender differences in diabetes mellitus and effects on self-care activity. Gend Med 2005, 2:246-254.
• [43]American Diabetes Association Position Statement: Standards of Medical Care in Diabetes-2012. Diabetes Care 2012, 35(Suppl):11-63.
• [44]Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS: Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes. Diabetes Care 2012, 35:434-445.
• [45]Djoussé L, Arnett DK, Coon H, Province MA, Moore LL, Ellison RC: Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr 2004, 79:213-217.
• [46]Simin L, Manson JA, Lee IM, Cole SR, Hennekens CH, Willett WC, Buring JE: Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. Am J Clin Nutr 2000, 72:922-928.
• [47]Will JC, Galuska DA, Ford ES, Mokdad A, Calle EE: Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J Epidemiol 2001, 30:540-546.
• [48]Eliasson B: Cigarette smoking and diabetes. Prog Cardiovasc Dis 2003, 45:405-413.
• [49]Gucciardi E, Rebecca Mathew R, DeMelo M, Bondy SJ: Profiles of smokers and non-smokers with type 2 diabetes: initial visit at a diabetes education centers. Prim Care Diabetes 2011, 5:185-194.
• [50]Anderson RJ, Freedland KE, Clouse RE, Lustman PJ: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001, 24(6):1069-1078.
• [51]Grigsby AB, Anderson RJ, Freedland KE, et al.: Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 2002, 53:1053-1060.
• [52]Delamater AM, Jacobson AM, Anderson B, et al.: Psychosocial therapies in diabetes. Report of the Psychosocial Therapies Working Group. Diabetes Care 2001, 24:1286-1292.