Kacerovsky-Bielesz G, Lienhardt S, Hagenhofer M, Kacerovsky M, Forster E, Roth R, Roden M
Medical Department, Hanusch Hospital, Vienna, Austria.
Diabetologia. 2009 May;52(5):781-8. doi: 10.1007/s00125-009-1318-7. Epub 2009 Mar 10.
AIMS/HYPOTHESIS: 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.
CONCLUSIONS/INTERPRETATION: 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.
目的/假设：女性患糖尿病相关心血管并发症的风险高于男性。我们检验了以下假设：在糖代谢控制以及社会和心理因素方面存在性别差异。我们还研究了这些因素对糖代谢控制的影响。
我们对一家大都市糖尿病门诊服务中心的257例（126名男性/131名女性）连续患者（64±9岁，均值±标准差）进行了研究，采用临床检测和标准化心理问卷。
女性和男性的平均糖化血红蛋白（HbA1c）（7.6±1.2%）无差异。服用口服降糖药的女性患者对糖尿病的了解程度更高（p = 0.012）。她们采用了更多应对糖尿病的策略，包括宗教（p = 0.0001）、积极应对（p = 0.048）和分散注意力（p = 0.007）。女性对社会支持的满意度较低（p = 0.034），但抑郁程度并不比男性更严重。虽然在依从性方面未观察到差异，但接受胰岛素治疗的患者对其治疗更满意（p = 0.007）。预测代谢控制不佳的变量在男性（R2 = 0.737，p = 0.012）和女性（R2 = 0.597，p = 0.019）中有所不同。糖化血红蛋白（HbA1c）升高的主要预测因素包括消极应对、性欲降低、生活质量和内控点，但女性中与医生相关的高外控点以及男性中高血糖的频繁情绪体验也起作用。
结论/解读：尽管女性对糖尿病的了解更好且应对努力更大，但生活质量较低、内控和社会经济地位较低以及负面情绪患病率较高可能阻碍了女性患者实现更好的血糖控制。我们建议，女性患者将从提供社会支持的个体化糖尿病护理中受益，而男性将从给予他们更多信息和工具性支持的基于知识的糖尿病管理中受益。
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