To describe sex-related differences in self-care; to identify determinants of self-care according to sex, and to investigate how sex interacts with the effect of clinical and socio-demographic variables on self-care in adults with Type 2 Diabetes Mellitus (T2DM).
Cross-sectional multicentre study with a consecutive sampling recruitment strategy, enrolling 540 adults with T2DM at six outpatient diabetes services. Clinical and socio-demographic variables were collected by medical records. Self-care maintenance, monitoring, management, and confidence were measured by the self-care of diabetes inventory.
Females reported higher disease prevention behaviors (P < 0.001), health-promoting behaviors (P < 0.001), body listening (P < 0.001), and symptom recognition (P = 0.010), but lower health-promoting exercise behaviors (P < 0.001). Determinants of self-care were different in male and female patients, where the role of task-specific self-care confidence predicted self-care monitoring (RR = 0.98; P < 0.001) and management (RR = 0.99; P < 0.001) among males, while persistence self-care confidence predicted self-care maintenance (RR = 0.97; P = 0.016) and management (RR = 0.99; P = 0.009) among females.
Males and females differently perform self-care. Self-care confidence plays a different role predicting self-care behaviors in males and females. Future research should longitudinally describe self-care and its determinants in males and females with T2DM. Sex-specific self-care confidence interventions should be developed to improve self-care in male and female patients with T2DM.
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A. Asghar, N. Sheikh, Role of immune cells in obesity induced low grade inflammation and insulin resistance. Cell. Immunol. 315, 18–26 (2017). https://doi.org/10.1016/j.cellimm.2017.03.001
IDF. IDF diabetes atlas, 8th edn. 2017, p. 1–145. https://diabetesatlas.org/resources/2017-atlas.html. Accessed 15 May 2019
N.G. Forouhi, N.J. Wareham, Epidemiology of diabetes. Medicine 42, 698–702 (2014). https://doi.org/10.1016/j.mpmed.2014.09.007
J.E. Tamis-Holland, J. Lu, M. Korytkowski, M. Magee, W.J. Rogers, N. Lopes et al. Sex differences in presentation and outcome among patients with type 2 diabetes and coronary artery disease treated with contemporary medical therapy with or without prompt revascularization. J. Am. Coll. Cardiol. 61, 1767–1776 (2013). https://doi.org/10.1016/j.jacc.2013.01.062
S.H. Hendriks, K.J.J. van Hateren, K.H. Groenier, S.T. Houweling, A.H.E.M. Maas, N. Kleefstra et al. Sex differences in the quality of diabetes care in the Netherlands (ZODIAC-45). PLOS ONE 10, e0145907 (2015). https://doi.org/10.1371/journal.pone.0145907
M.R. Lyons, L.R. Peterson, J.B. McGill, P. Herrero, A.R. Coggan, I.M. Saeed et al. Impact of sex on the heart’s metabolic and functional responses to diabetic therapies. Am. J. Physiol. 305, H1584–H1591 (2013). https://doi.org/10.1152/ajpheart.00420.2013
M. Schunk, P. Reitmeir, S. Schipf, H. Völzke, C. Meisinger, K.-H. Ladwig et al. Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups. J. Diab. Complicat. 29, 203–211 (2015). https://doi.org/10.1016/J.JDIACOMP.2014.11.010
G. Kacerovsky-Bielesz, S. Lienhardt, M. Hagenhofer, M. Kacerovsky, E. Forster, R. Roth et al. Sex-related psychological effects on metabolic control in type 2 diabetes mellitus. Diabetologia 52, 781–788 (2009). https://doi.org/10.1007/s00125-009-1318-7
J.E.B. Reusch, T.R. Kumar, J.G. Regensteiner, P.S. Zeitler, Z. Arany, C.N. Bairey Merz et al. Identifying the critical gaps in research on sex differences in metabolism across the life span. Endocrinology 159, 9–19 (2018). https://doi.org/10.1210/en.2017-03019
W.S. Jones, B.D. Duscha, J.L. Robbins, N.N. Duggan, J.G. Regensteiner, W.E. Kraus et al. Alteration in angiogenic and anti-angiogenic forms of vascular endothelial growth factor-A in skeletal muscle of patients with intermittent claudication following exercise training. Vasc. Med. 17, 94–100 (2012). https://doi.org/10.1177/1358863X11436334
R. Caruso, A. Magon, I. Baroni, F. Dellafiore, C. Arrigoni, F. Pittella et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 55, 1–12 (2018). https://doi.org/10.1007/s00592-017-1071-1
Y.-J. Lee, S.-J. Shin, R.-H. Wang, K.-D. Lin, Y.-L. Lee, Y.-H. Wang, Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ. Couns. 99, 287–294 (2016). https://doi.org/10.1016/J.PEC.2015.08.021
M. Song, Diabetes mellitus and the importance of self-care. J. Cardiovasc. Nurs. 25, 93–98 (2010). https://doi.org/10.1097/JCN.0b013e3181c5a364
D. Ausili, M. Bulgheroni, P. Ballatore, C. Specchia, A. Ajdini, S. Bezze et al. Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol. 54, 1001–1008 (2017). https://doi.org/10.1007/s00592-017-1035-5
D. Ausili, E. Rossi, P. Rebora, M. Luciani, L. Tonoli, E. Ballerini et al. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol3 55, 691–702 (2018). https://doi.org/10.1007/s00592-018-1135-x
M.A. Powers, J. Bardsley, M. Cypress, P. Duker, M.M. Funnell, A. Hess Fischl et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diab. Care 38, 1372–1382 (2015). https://doi.org/10.2337/dc15-0730
B. Riegel, T. Jaarsma, A. Strömberg, A middle-range theory of self-care of chronic illness. Adv. Nurs. Sci. 35, 194–204 (2012). https://doi.org/10.1097/ANS.0b013e318261b1ba
F. Dellafiore, C. Arrigoni, F. Pittella, G. Conte, A. Magon, R. Caruso, Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study. BMJ Open 8, e021966 (2018). https://doi.org/10.1136/bmjopen-2018-021966
F. Dellafiore, G. Conte, I. Baroni, A. Magon, F. Pittella, L. Casole et al. Gender differences in heart failure self-care behaviors: do we know enough? Minerva Med. 109, 401–403 (2018). https://doi.org/10.23736/S0026-4806.18.05579-9
R. Caruso, C. Arrigoni, A. Magon, F. Pittella, F. Dellafiore, A. Grugnetti et al. Health determinants in italian type 2 diabetes Mellitus (T2DM) patients: a critical gender differences analysis. J. Res. Gend. Stud. 7, 93–108 (2017). https://doi.org/10.22381/JRGS7220176
D. Rajasekharan, V. Kulkarni, B. Unnikrishnan, N. Kumar, R. Holla, R. Thapar, Self-care activities among patients with diabetes attending a tertiary care hospital in mangalore karnataka, India. Ann. Med. Health Sci. Res. 5, 59–64 (2015). https://doi.org/10.4103/2141-9248.149791
D. Ausili, C. Barbaranelli, E. Rossi, P. Rebora, D. Fabrizi, C. Coghi et al. Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the self-care of diabetes inventory. BMC Endocr. Disord. 17, 66 (2017). https://doi.org/10.1186/s12902-017-0218-y
R. Caruso, P. Rebora, F. Dellafiore, D. Fabrizi, B. Riegel, D. Ausili et al. Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence. Acta Diabetologica 56, 151–161 (2019). https://doi.org/10.1007/s00592-018-1259-z
T. Lumley, R. Kronmal, S. Ma, Relative risk regression in medical research: models, contrasts, estimators, and algorithms. UW Biostatistics Working Paper Series, Working Paper 293 (2006). https://biostats.bepress.com/uwbiostat/paper293
P. Karaca-Mandic, E.C. Norton, B. Dowd, Interaction terms in nonlinear models. Health Serv. Res. 47, 255–274 (2012). https://doi.org/10.1111/j.1475-6773.2011.01314.x
G. Pucci, R. Alcidi, L. Tap, F. Battista, F. Mattace-Raso, G. Schillaci, Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: a review of the literature. Pharmacol. Res. 120, 34–42 (2017). https://doi.org/10.1016/J.PHRS.2017.03.008
L. Arnetz, N.R. Ekberg, M. Alvarsson, Sex differences in type 2 diabetes: focus on disease course and outcomes. Diabetes, Metab. Syndr. Obes. 7, 409–420 (2014). https://doi.org/10.2147/DMSO.S51301
B.B. Craft, H.A. Carroll, M.K.B. Lustyk, Gender differences in exercise habits and quality of life reports: assessing the moderating effects of reasons for exercise. Int. J. Lib. Arts Soc. Sci. 2, 65–76 (2014)
G.F. Fletcher, C. Landolfo, J. Niebauer, C. Ozemek, R. Arena, C.J. Lavie, Promoting physical activity and exercise. J. Am. Coll. Cardiol. 72, 1622–1639 (2018). https://doi.org/10.1016/j.jacc.2018.08.2141
B.D. Mattan, J.T. Kubota, J. Cloutier, How social status shapes person perception and evaluation: a social neuroscience perspective. Perspect. Psychol. Sci. 12, 468–507 (2017). https://doi.org/10.1177/1745691616677828
C. Fine, J. Dupré, D. Joel, Sex-linked behavior: evolution, stability, and variability. Trends Cogn. Sci. 21, 666–673 (2017). https://doi.org/10.1016/J.TICS.2017.06.012
F. Dellafiore, D. Rosa, F. Pittella, MP. Caruso, M. Allemano, R. Caruso, The impact of type 2 diabetes diagnosis on married couples. J. Diab. Nurs. 22, [JDN12] (2018).
M. Luciani, P. Rebora, E. Rossi, L Tonoli, S. Androni, E. Ballerini, et al, How do basic human values affect self-care of type 2 diabetes patients? A multicentre observational study. Clin. Nurs. Res. 2019:105477381882500. https://doi.org/10.1177/1054773818825003.
R.I.G. Holt, A. Nicolucci, K. Kovacs Burns, M. Escalante, A. Forbes, N. Hermanns et al. Diabetes attitudes, wishes and needs second study (DAWN2TM): cross-national comparisons on barriers and resources for optimal care-healthcare professional perspective. Diabet. Med. 30, 789–798 (2013). https://doi.org/10.1111/dme.12242
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Caruso, R., Rebora, P., Luciani, M. et al. Sex-related differences in self-care behaviors of adults with type 2 diabetes mellitus. Endocrine (2020) doi:10.1007/s12020-020-02189-5
- Type 2 diabetes mellitus
- Sex characteristics