An excellent article concerning men and diabetes, “Men and Diabetes: Psychosocial and Behavioral Issues,” by Rubin, Richard R. P.H., CDE, and Peyrot, Mark, Ph.D. We are please to bring you a synopsis of this article as an answer to many questions we receive daily from men who have diabetes. The results may surprise you and allow some of you care takers out there to feel less guilty when you allow that man in your life to care for himself.
This research which examined patients at the Johns Hopkins Diabetes Center adult outpatient education program, looks at the reciprocal relationship among psychosocial facts (such as health beliefs, social support, quality of life, and emotional well being), self care behavior, and physical health outcomes (such as glycemic control and complications). The researchers inferring that helping people manage their lives requires an understanding of all of these factors and their interconnections.
One factor that determines how people manage disease is gender. There is a body of research that indicates that men and women differ in health-related attitudes and behavior. For example in acute disease, men are found to be less sensitive to the illness, less about rest during illness, and less willing to seek medical advice. Men report fewer illnesses, use less medical services, and have a smaller network of people with whom they discuss illness. In general, men are less involved in taking responsibility for family health and ten to be more stoic than women.
Less is known about gender differences relating to chronic illness and how they are related to attitudes and behavior, but what we do know, tends to mirror the findings of acute illness. The role of gender in diabetes-related psychosocial adaptation, self-care, and physical health outcomes was largely unstudied before the study. The authors looked at patients over a 10 year period who were asked to fill out a series of questionnaires, a qualitative review of the literature, and their own clinical experiences.
They examined the following areas:
- Diabetes-related beliefs and attitudes
- Social support
- Self-care behavior, glycemic control, and complications
- Quality of life and emotional well-being
Results are as follows:
Diabetes-related beliefs and attitudes:
Men had a higher total diabetes self-efficacy score then women, that is they felt more confident about managing their diabetes than women. They were less likely to feel that their health outcomes were a result of fate or some external force. Men reported that they were in control of their disease and had control of any medical complications, long or short term. Men reported fewer episodes of hyperglycemia and lower levels of self-reported depression and anxiety. Spousal reports tended to confirm these findings, that is that men felt more confident and competent in their own ability to manage diabetes.
Male patients reported more satisfaction with diabetes-related practical help and diabetes-related emotional support from spouses than did female patients. Moreover, wives of patients reported fewer hassles over medication and testing blood glucose levels than did spouses of female patients. Men received more support from their partners than did women in this study as evidenced by the number of spouses of male patients who attended education programs and who completed questionnaires as compared to husbands of diabetic females.
Self-care behavior, glycemic control, and complications:
Researchers asked participants information about glycemic control as measured by the HbA1c assay and any complications from medical histories. Men reported better self-care than women in a number of areas, including eating meals on time, less binge eating, and fewer late insulin injections. Men reported fewer incidents of ketonuria and better HbA1c levels. Men also had fewer diabetes-related complications. No gender differences were found in any measure of physical exercise, glucose or ketone monitoring, or symptoms of hypoglycemia.
Quality of life and emotional well being:
This was thought to be a very important area of the research because some previous research suggests that diabetics have higher levels of psychological disturbance, especially depression, than the general population. Diabetes may contribute to emotional stress and may increase an individual’s risk for symptoms of depression.
In turn, poor quality of life and emotional distress may compromise a person’s ability to maintain adequate levels of self-care. Thus it was felt important to understand an individual’s quality of life and emotional well-being as related to how diabetes is managed. Results indicated that men reported more satisfaction with their diet than did women.
They were also more satisfied with their diabetes treatment regime. Men were less likely to miss work or activities because of their diabetes than were women. Wives of men with diabetes reported less emotional stress caused by diabetes. They felt that their futures would be less affected by their husband’s diabetes. On the other hand, wives of diabetics tended to miss more work and other activities because of their husband’s diabetes, than did husbands of female diabetics.
It was felt that this was a mirror of the female role of caretaker in families. No gender difference in spousal or patient reports of quality of life for most items was noted. The analysis of findings of this study did show that women were more than twice as likely as men to have depression or an anxiety disorder.
To reiterate the findings of this study:
- Men were found to be more confident in their ability to control diabetes.
- Men reported that they felt more support and less hassle from wives about diabetes management.
- Men tended to have lower HbA1c levels and fewer medical complications.
- Men reported higher quality of life.
- Men were less likely to report significant levels of depression and anxiety.
Implications for Research, Clinical Care, and Education
It is time to replicate these findings as these are a starting point. One question to be addressed is whether these findings are based on fact or artifact. After all, men may be less able or willing to report problems, and have more at stake to be a success. Although spousal reports and medical history seem to correlate with the findings, more objective evidence regarding gender differences would be important. If the differences are real, we need to do research to better understand them. They would have important implications on treatment and education for diabetics of both genders. Also, if it is true that men are better self-care-givers, is that because they are inherently better or do they demand better intervention and support?
Clinical and Educational Implications:
We can not make blanket generalities from its report. There are certainly men who need more and women who need less support and education. It would be wrong to spend more dollars on women than men based on this one study. The researchers call for individualized assessments of quality of life on one hand, and self-care behavior and glycemic control on the other. It is important to assess these areas and rate the level to which each person is dependent on social support.
If, for example, someone’s success is based on significant support, but that support system is overtaxed, then interventions need to be devised to protect those who are overwhelmed. If a person is doing less well in any of the areas researched, then interventions appropriate for that person and family need to be put into effect. The reasoning behind this goes back to the initial premise of this research, which is that all areas of life with diabetes are inextricably intertwined with each aspect affecting the others.
Therefore, a positive change in one area will positively effect all others. Understanding how a person looks at maintaining a quality life-style, whether pragmatic, as more men appear to do, means that these men will need to have treatment which plays to their strengths and sense of practicality. It does not mean that they will not need special support if they are struggling with diabetes management.
All assessments should identify and address underlying beliefs interfering with self-care, physical well-being, and quality of life. Attention should be given to dispelling ideas that management has anything to do with a fundamental lack of competence or manhood. This does not mean that sensitivity to emotional issues is not important to men; it is, but broaching these issues may be better served by talking about how other men cope than by demanding emotional catharsis. Again, this article named behaviors; now we need to go further into understanding why.
This article is a good stepping off point for this further research. We will keep our eyes open for more and share it with you as it becomes available. It does not say anything that we did not already know, but seeing it in print with thoughtful research makes it easier to understand those differences we all notice on a daily basis when dealing with men and women with chronic diseases. What I would add is “Vive la difference!” How boring life would be if we all reacted to everything the same way. As we share information, we can share attitudes, and hopefully feel more at ease with our own ability to maintain health.