Sex-related psychological effects on metabolic control in type 2 diabetes mellitus

Women are at higher risk of diabetes-related cardiovascular complications than men. We tested the hypothesis that there are sex-specific differences in glucometabolic control, and in social and psychological factors. We also examined the influence of these factors on glucometabolic control.

We examined 257 (126 men/131 women) consecutive patients (64 +/- 9 years, means +/- SD) of a metropolitan diabetes outpatient service employing clinical testing and standardised psychological questionnaires.

Mean HbA(1c) (7.6 +/- 1.2%) was not different between women and men. Women patients on oral hypoglycaemic agents were better informed about diabetes (p = 0.012). They employed more strategies for coping with diabetes, including religion (p = 0.0001), active coping (p = 0.048) and distraction (p = 0.007). Women reported lower satisfaction with social support (p = 0.034), but not more depression than men. Although no differences were observed in compliance, insulin-treated patients were more satisfied with their therapy (p = 0.007). Variables predicting poor metabolic control were different in men (R(2) = 0.737, p = 0.012) and women (R(2) = 0.597, p = 0.019). Major predictors of high HbA(1c) included depressive coping, lower sexual desire, quality of life and internal locus of control, but high external doctor-related locus of control in women and frequent emotional experiences of hyperglycaemia in men.

Lower quality of life, internal control and socioeconomic status, and higher prevalence of negative emotions probably prevented woman patients from achieving improved glucose control despite their better knowledge of and greater efforts to cope with diabetes. We suggest that women patients would benefit from individualised diabetes care offering social support, whereas men would benefit from knowledge-based diabetes management giving them more informational and instrumental support.