Barriers to Type 2 Diabetes Management in Australian Gay Cisgender Men: First National Study

The study sought to determine how sexual orientation impacts the experience and management of type 2 diabetes (T2D) because psychosocial factors are known to have a significant impact on clinical outcomes. This was to address the gap in research on how Australian men assigned male at birth who identify as male and gay may influence the management of T2D and improve awareness among health-care providers and gay men living with T2D.

A sequential mixed-methods design was used to explore the experiences of Australian men assigned male at birth, who identify as male and gay with T2D. Two data collection phases started with an electronic survey of 83 gay men with T2D (7 screening questions and 63 questions covering characteristics and where sexuality and diabetes intersect) and 82 without T2D (5 questions covering thoughts on gay men with T2D), to explore community perceptions, followed by a second phase of 12 in-depth interviews with gay men with T2D.

Descriptive statistics were used to analyze the survey data, and a reflexive thematic analysis, grounded in constructivist assumptions, was used for interview data. Twenty-one percent of participants had not disclosed their sexual orientation to their doctor, indicating a prevalent barrier. Three themes emerged that reduce the ability of gay men to bring their whole selves into health-care consultations, creating a barrier, including 1) discomfort around sexual orientation and diabetes; 2) navigating uncomfortable patient-provider conversations; and 3) sexuality and diabetes: unrecognized connections in lifestyle factors.

These findings underscore the need for tailored interventions by diabetes specialists or educators to address identity-related barriers and potentially reduce diabetes-related complications.