Skip to main content
SpringerLink
Log in

Gender Differences in Functional Limitations in Adults Living with Type 2 Diabetes: Biobehavioral and Psychosocial Mediators

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men.

Purpose

This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender–functional limitations relationship in adults with type 2 diabetes.

Methods

We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling.

Results

Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender–functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender–functional limitations relationship.

Conclusions

Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gregg EW, Beckles GL, Williamson DF et al. Diabetes and physical disability among older U.S. adults. Diabetes care. 2000 Sep;23(9):1272–7.

    Article  CAS  PubMed  Google Scholar 

  2. Gregg EW, Engelgau MM, Narayan V. Complications of diabetes in elderly people: Underappreciated problems include cognitive decline and physical disability. British Medical Journal. 2002 Oct 26;325(7370):916–7.

    Article  PubMed  Google Scholar 

  3. Gregg EW, Mangione CM, Cauley JA et al. Diabetes and incidence of functional disability in older women. Diabetes care. 2002 Jan;25(1):61–7.

    Article  PubMed  Google Scholar 

  4. Ryerson B, Tierney EF, Thompson TJ et al. Excess physical limitations among adults with diabetes in the U.S. population, 1997–1999. Diabetes care. 2003 Jan;26(1):206–10.

    Article  PubMed  Google Scholar 

  5. Bruce DG, Casey GP, Grange V et al. Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: The Fremantle Cognition in Diabetes Study. Diabetes research and clinical practice. 2003 Jul;61(1):59–67.

    Article  PubMed  Google Scholar 

  6. Bruce DG, Davis WA, Davis TM. Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: The Fremantle Diabetes Study. Diabetes care. 2005 Oct;28(10):2441–7.

    Article  PubMed  Google Scholar 

  7. Wu JH, Haan MN, Liang J et al. Impact of diabetes on cognitive function among older Latinos: A population-based cohort study. Journal of clinical epidemiology. 2003 Jul;56(7):686–93.

    Article  PubMed  Google Scholar 

  8. Wu JH, Haan MN, Liang J et al. Diabetes as a predictor of change in functional status among older Mexican Americans: A population-based cohort study. Diabetes care. 2003 Feb;26(2):314–9.

    Article  PubMed  Google Scholar 

  9. Songer TJ. Disability in Diabetes. In: Harris M, Gowie CC, Stern M et al., eds. Diabetes in America. 2nd ed. Washington DC: U.S. Govt. Printing Office: NIH publ. no. 95–1468 1995:429–48.

  10. Wray LA, Ofstedal MB, Langa KM, Blaum CS. The effect of diabetes on disability in middle-aged and older adults. The journals of gerontology. 2005 Sep;60(9):1206–11.

    PubMed  Google Scholar 

  11. Maggi S, Noale M, Gallina P et al. Physical disability among older Italians with diabetes. The ILSA study. Diabetologia. 2004 Nov;47(11):1957–62.

    Article  CAS  Google Scholar 

  12. Wang L, van Belle G, Kukull WB, Larson EB. Predictors of functional change: A longitudinal study of nondemented people aged 65 and older. Journal of the American Geriatrics Society. 2002 Sep;50(9):1525–34.

    Article  PubMed  Google Scholar 

  13. Chou KL, Chi I. Functional disability related to diabetes mellitus in older Hong Kong Chinese adults. Gerontology. 2005 Sep–Oct;51(5):334–9.

  14. Shalev V, Chodick G, Heymann AD, Kokia E. Gender differences in healthcare utilization and medical indicators among patients with diabetes. Public Health. 2005 Jan;119(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  15. Chiu CJ, Wray LA. Physical Disability Trajectories in Older Americans with and without Diabetes: The Role of Age, Gender, Race/ethnicity and Education. The Gerontologist. 2010;In Press.

  16. Romoren TI, Blekeseaune M. Trajectories of disability among the oldest old. J Aging Health. 2003 Aug;15(3):548–66.

    Article  PubMed  Google Scholar 

  17. Gorman BK, Read JG. Gender disparities in adult health: An examination of three measures of morbidity. J Health Soc Behav. 2006 Jun;47(2):95–110.

    Article  PubMed  Google Scholar 

  18. Freedman VA, Crimmins E, Schoeni RF et al. Resolving inconsistencies in trends in old-age disability: Report from a technical working group. Demography. 2004 Aug;41(3):417–41.

    Article  PubMed  Google Scholar 

  19. Barberger-Gateau P, Rainville C, Letenneur L, Dartigues JF. A hierarchical model of domains of disablement in the elderly: A longitudinal approach. Disabil Rehabil. 2000 May 10;22(7):308–17.

    Article  CAS  PubMed  Google Scholar 

  20. Beckett LA, Brock DB, Lemke JH et al. Analysis of change in self-reported physical function among older persons in four population studies. Am J Epidemiol. 1996 Apr 15;143(8):766–78.

    CAS  PubMed  Google Scholar 

  21. Shumway-Cook A, Ciol MA, Yorkston KM et al. Mobility limitations in the Medicare population: Prevalence and sociodemographic and clinical correlates. Journal of the American Geriatrics Society. 2005 Jul;53(7):1217–21.

    Article  PubMed  Google Scholar 

  22. Alwin DF, Wray LA. A life-span developmental perspective on social status and health. J Gerontol B Psychol Sci Soc Sci. 2005 Oct;60 Spec No 2:7–14.

  23. Strawbridge WJ, Camacho TC, Cohen RD, Kaplan GA. Gender differences in factors associated with change in physical functioning in old age: A 6-year longitudinal study. Gerontologist. 1993 Oct;33(5):603–9.

    CAS  PubMed  Google Scholar 

  24. Newman AB, Brach JS. Gender gap in longevity and disability in older persons. Epidemiol Rev. 2001;23(2):343–50.

    CAS  PubMed  Google Scholar 

  25. Wexler DJ, Grant RW, Meigs JB et al. Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diabetes care. 2005 Mar;28(3):514–20.

    Article  PubMed  Google Scholar 

  26. Nilsson PM, Theobald H, Journath G, Fritz T. Gender differences in risk factor control and treatment profile in diabetes: A study in 229 swedish primary health care centres. Scand J Prim Health Care. 2004 Mar;22(1):27–31.

    Article  PubMed  Google Scholar 

  27. Tang YH, Pang SM, Chan MF et al. Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. J Adv Nurs. 2008 Apr;62(1):74–83.

    Article  PubMed  Google Scholar 

  28. Legato MJ, Gelzer A, Goland R et al. Gender-specific care of the patient with diabetes: Review and recommendations. Gend Med. 2006 Jun;3(2):131–58.

    Article  PubMed  Google Scholar 

  29. Szalat A, Raz I. Gender-specific Care of Diabetes. Women's Health. 2007;3(6):735–64.

    PubMed  Google Scholar 

  30. Glasgow RE, McCaul KD, Schafer LC. Barriers to regimen adherence among persons with insulin-dependent diabetes. J Behav Med. 1986 Feb;9(1):65–77.

    Article  CAS  PubMed  Google Scholar 

  31. Walker EA, Molitch M, Kramer MK et al. Adherence to preventive medications: Predictors and outcomes in the Diabetes Prevention Program. Diabetes care. 2006 Sep;29(9):1997–2002.

    Article  PubMed  Google Scholar 

  32. Gucciardi E, Wang SC, DeMelo M et al. Characteristics of men and women with diabetes: Observations during patients’ initial visit to a diabetes education centre. Can Fam Physician. 2008 Feb;54(2):219–27.

    PubMed  Google Scholar 

  33. Ponzo MG, Gucciardi E, Weiland M et al. Gender, ethnocultural, and psychosocial barriers to diabetes self-management in Italian women and men with type 2 diabetes. Behav Med. 2006 Winter; 31(4):153–60.

  34. Chiu CJ, Wray LA, Beverly EA, Dominic OG. The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: A structural equation modeling approach. Social Psychiatry and Psychiatric Epidemiology. 2009, in press.

  35. Brown SA, Harrist RB, Villagomez ET et al. Gender and treatment differences in knowledge, health beliefs, and metabolic control in Mexican Americans with type 2 diabetes. Diabetes Educ. 2000 May–Jun;26(3):425–38.

    Article  CAS  PubMed  Google Scholar 

  36. Umberson D. Gender, marital status, and the social control of health behavior. Social Science and Medicine. 1992;34:907–17.

    Article  CAS  PubMed  Google Scholar 

  37. Verbrugge LM, Jette AM. The disablement process. Soc Sci Med. 1994 Jan;38(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  38. Juster FT, Suzman R. An overview of the Health and Retirement Study. The Journal of Human Resources. 1995;30(Special Issue on the Health and Retirement Study: Data Quality and Early Results):S7–S56.

  39. Flexsite. A1c At-Home(R) From Dried Blood Spots: A Precise and Accurate Methodology. 2008 [cited March 5, 2010]; Available from: http://www.flexsite.com/Professional_A1c.html.

  40. Kannel WB. Elevated systolic blood pressure as a cardiovascular risk factor. Am J Cardiol. 2000 Jan 15;85(2):251–5.

    Article  CAS  PubMed  Google Scholar 

  41. Kannel WB. Fifty years of Framingham Study contributions to understanding hypertension. J Hum Hypertens. 2000 Feb;14(2):83–90.

    Article  CAS  PubMed  Google Scholar 

  42. Marshall SM, Flyvbjerg A. Prevention and early detection of vascular complications of diabetes. BMJ. 2006 Sep 2;333(7566):475–80.

    Article  PubMed  Google Scholar 

  43. Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: A meta-analysis. Diabetes care. 2003 Jun;26(6):1895–901.

    Article  PubMed  Google Scholar 

  44. Vinik AI. Management of neuropathy and foot problems in diabetic patients. Clin Cornerstone. 2003;5(2):38–55.

    Article  PubMed  Google Scholar 

  45. Vinik AI, Vinik E. Prevention of the complications of diabetes. Am J Manag Care. 2003 Mar;9(3 Suppl):S63–80; quiz S1–4.

    PubMed  Google Scholar 

  46. The Health and Retirement Study. 2003 Diabetes Study. The Health and Retirement Study 2007 [cited 2010 May 3 rd]; Available from: http://hrsonline.isr.umich.edu/modules/meta/diabetes/desc/diab2003.pdf

  47. Wallhagen MI, Lacson M. Perceived control and psychosocial/physiological functioning in African American elders with type 2 diabetes. Diabetes Educ. 1999 Jul–Aug;25(4):568–75.

    Article  CAS  PubMed  Google Scholar 

  48. Bijl JV, Poelgeest-Eeltink AV, Shortridge-Baggett L. The psychometric properties of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus. J Adv Nurs. 1999 Aug;30(2):352–9.

    Article  CAS  PubMed  Google Scholar 

  49. Radloff L. The CES-D Scale. Applied Psychological Measurement. 1977;1(3):385–401.

    Article  Google Scholar 

  50. Fitzgerald JT, Davis WK, Connell CM et al. Development and validation of the Diabetes Care Profile. Eval Health Prof. 1996 Jun;19(2):208–30.

    Article  CAS  PubMed  Google Scholar 

  51. Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes care. 1997 May;20(5):760–6.

    Article  CAS  PubMed  Google Scholar 

  52. Katz S, Ford AB, Moskowitz RW et al. Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function. JAMA. 1963 Sep 21;185:914–9.

    CAS  PubMed  Google Scholar 

  53. Lawton MP, Brody E. Assessment of Older People: Self-maintaining and Instrumental Activities of Daily Living. The Gerontologist. 1969;9:179–86.

    CAS  PubMed  Google Scholar 

  54. Nagi SZ. A Study in the Evaluation of Disability and Rehabilitation Potential: Concepts, Methods, and Procedures. Am J Public Health Nations Health. 1964 Sep;54:1568–79.

    Article  CAS  PubMed  Google Scholar 

  55. Joreskog KG, Sorbom D. LISREL 8: User’s reference guide. Lincolnwood, IL: Scientific Software International, Inc. 1999.

    Google Scholar 

  56. Anderson JC, Gerbing DW. The effect of sampling error on convergence, improper solutions, and goodness-of-fit indices for maximum likelihood confirmatiory factor analysis. Psychometrika. 1984;49:155–73.

    Article  Google Scholar 

  57. Marsh HW, Bajaj JR, MacDonald RP. Goodness-of-fit indexes in confirmatory factor analysis: The effect of sample size. Psychological Bulletin. 1988;103:391–410.

    Article  Google Scholar 

  58. Hu L, Bentler PM. Cutoff criteria for fit indices in covariance structure analysis: Conventional versus new alternatives. Structural Equation Modeling. 1999;6:1–55.

    Article  Google Scholar 

  59. Marsh HW, Hau K, Wen Z. In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s findings. Structural Equation Modeling. 2004;11:320–41.

    Article  Google Scholar 

  60. Enders CK, Bandalos DL. The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling. 2001;8:430–57.

    Article  Google Scholar 

  61. Graham JW, Hofer SM. Multiple imputation in multivariate research. NJ: Erlbaum: Hillsdale 2000.

  62. Enders CK, Peugh JL. Using an EM Covariance Matrix to Estimate Structural Equation Models With Missing Data: Choosing an Adjusted Sample Size to Improve the Accuracy of Inferences. Structural Equation Modeling. 2004;11(2):1–19.

    Article  Google Scholar 

  63. Baron RM, Kenny DA. The moderator-mediator variable distinciton in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.

    Article  CAS  PubMed  Google Scholar 

  64. Cohen J. A power primer. Psychological Bulletin. 1992;112:155–9.

    Article  CAS  PubMed  Google Scholar 

  65. Cohen J. Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum 1988.

    Google Scholar 

  66. Barrett JE, Plotnikoff RC, Courneya KS, Raine KD. Physical activity and type 2 diabetes: Exploring the role of gender and income. Diabetes Educ. 2007 Jan–Feb;33(1):128–43.

    Article  PubMed  Google Scholar 

  67. Trief PM, Ploutz-Snyder R, Britton KD, Weinstock RS. The relationship between marital quality and adherence to the diabetes care regimen. Ann Behav Med. 2004 Jun;27(3):148–54.

    Article  PubMed  Google Scholar 

  68. Karter AJ, Ackerson LM, Darbinian JA et al. Self-monitoring of blood glucose levels and glycemic control: The Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001 Jul;111(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  69. Hebert JR, Hurley TG, Peterson KE et al. Social desirability trait influences on self-reported dietary measures among diverse participants in a multicenter multiple risk factor trial. J Nutr. 2008 Jan;138(1):226S–34S.

    CAS  PubMed  Google Scholar 

  70. Hebert JR, Ma Y, Clemow L et al. Gender differences in social desirability and social approval bias in dietary self-report. Am J Epidemiol. 1997 Dec 15;146(12):1046–55.

    CAS  PubMed  Google Scholar 

  71. Jenkins KR, Ofstedal MB, Weir DR. Documentation of health behaviors and risk factors measured in the Health and Retirement Study (HRS/AHEAD). HRSAHEAD Documentation Report 2008 [cited 2010 May 3]; Available from: http://hrsonline.isr.umich.edu/sitedocs/userg/dr-010.pdf

  72. Colditz GA, Martin P, Stampfer MJ et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. 1986 May;123(5):894–900.

    CAS  PubMed  Google Scholar 

  73. Bowman RL, DeLucia JL. Accuracy of self-reported weight: A meta-analysis. Behavior Therapy. 1992;23:637–55.

    Article  Google Scholar 

  74. Glymour MM, Avendano M. Can self-reported strokes be used to study stroke incidence and risk factors?: Evidence from the health and retirement study. Stroke. 2009 Mar;40(3):873–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grant R21-DK078894 from the National Institute on Diabetes and Digestive and Kidney Disorders, National Institutes of Health. The earlier version of this paper was presented in the Society of Behavioral Medicine’s 30th annual meeting on April 22–25, 2009 in Montreal, Quebec, Canada.

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Biobehavioral Health, The Pennsylvania State University, 315 HHD East, University Park, PA, 16802, USA

    Ching-Ju Chiu Ph.D. & Linda A. Wray Ph.D.

Authors
  1. Ching-Ju Chiu Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda A. Wray Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ching-Ju Chiu Ph.D..

About this article

Cite this article

Chiu, CJ., Wray, L.A. Gender Differences in Functional Limitations in Adults Living with Type 2 Diabetes: Biobehavioral and Psychosocial Mediators. ann. behav. med. 41, 71–82 (2011). https://doi.org/10.1007/s12160-010-9226-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-010-9226-0

Keywords

Search

Navigation