Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences

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Irene Baroni
Rosario Caruso
Federica Dellafiore
Davide Ausili
Serena Barello
Ida Vangone
Sara Russo
Arianna Magon
Gianluca Conte
Luca Guardamagna
Cristina Arrigoni

Keywords

Self-care behaviors, Sex-related difference, Type 2 diabetes mellitus

Abstract

 T2DM is a multifactorial disease, and it is considered a worldwide challenge for its increasing prevalence and its negative impact on patients’ wellbeing. Even if it is known that self-care is a key factor in reaching optimal outcomes, and males and females implement different self-care behaviors, sex-related differences in self-care of patients with T2DM have been poorly investigated. Especially, an overall view of the available evidence has not yet been done. Accordingly, this review aims to summarize, critically review, and interpret the available evidence related to the sex-related differences in self-care behaviors of patients with T2DM.


An extensive literature review was performed with a narrative synthesis following the PRISMA statement and flowchart through four databases: PubMed, CINAHL, Scopus, and Embase.


From the 5776 identified records by the queries, only 29 articles were included, having a high-quality evaluation. Both females and males with T2DM must improve their self-care: more males reported performing better behaviors aimed at maintaining health and clinical stability (i.e., self-care maintenance) than females, but mainly in relation to physical activity. On the other hand, more females reported performing adequate behaviors aimed at monitoring their signs and symptoms (i.e., self-care monitoring) but with worse glycemic control and diabetic complications (i.e., self-care management).


This review firstly provides an overall view of different self-care behaviors implemented by males and females with T2DM, showing that self-care management should be improved in both sexes. Health education must include the problems related to the diabetic pathology and the patient’s own characteristics, such as sex.

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References

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2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019 Nov;157:107843.

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6. Riegel B, Dickson VV, Faulkner KM. The Situation-Specific Theory of Heart Failure Self-Care: Revised and Updated. J Cardiovasc Nurs. 2016 Jun;31(3):226–35.

7. Ausili D, Rossi E, Rebora P, Luciani M, Tonoli L, Ballerini E, et al. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol. 2018 Jul;55(7):691–702.

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9. Baroni I, Arrigoni C, Caruso R, Magon A, Villa G, Manara DF, et al. Self-care and type 1 diabetes mellitus: systematic review of sex-related differences. Panminerva Med. 2021 Jan 25;

10. Dellafiore F, Arrigoni C, Pittella F, Conte G, Magon A, Caruso R. Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study. BMJ Open. 2018 Sep 28;8(9):e021966.

11. Riegel B, Jaarsma T. Recognizing the Complexity of Self-Care. Int J Nurs Stud. 2021 Apr;116:103908.

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20. Lyons MR, Peterson LR, McGill JB, Herrero P, Coggan AR, Saeed IM, et al. Impact of sex on the heart’s metabolic and functional responses to diabetic therapies. Am J Physiol Heart Circ Physiol. 2013 Dec 1;305(11):H1584-1591.

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References
1. WHO. Diabetes. World Health Organization. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes

2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019 Nov;157:107843.

3. American Association of Diabetes Educators. An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors®. Diabetes Educ. 2020 Apr;46(2):139–60.

4. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012 Sep;35(3):194–204.

5. Riegel B, Dickson VV. A situation-specific theory of heart failure self-care. J Cardiovasc Nurs. 2008 Jun;23(3):190–6.

6. Riegel B, Dickson VV, Faulkner KM. The Situation-Specific Theory of Heart Failure Self-Care: Revised and Updated. J Cardiovasc Nurs. 2016 Jun;31(3):226–35.

7. Ausili D, Rossi E, Rebora P, Luciani M, Tonoli L, Ballerini E, et al. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol. 2018 Jul;55(7):691–702.

8. Yu DS-F, De Maria M, Barbaranelli C, Vellone E, Matarese M, Ausili D, et al. Cross-cultural applicability of the Self-Care Self-Efficacy Scale in a multi-national study. J Adv Nurs. 2021 Feb;77(2):681–92.

9. Baroni I, Arrigoni C, Caruso R, Magon A, Villa G, Manara DF, et al. Self-care and type 1 diabetes mellitus: systematic review of sex-related differences. Panminerva Med. 2021 Jan 25;

10. Dellafiore F, Arrigoni C, Pittella F, Conte G, Magon A, Caruso R. Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study. BMJ Open. 2018 Sep 28;8(9):e021966.

11. Riegel B, Jaarsma T. Recognizing the Complexity of Self-Care. Int J Nurs Stud. 2021 Apr;116:103908.

12. Riegel B, Dunbar SB, Fitzsimons D, Freedland KE, Lee CS, Middleton S, et al. Self-care research: Where are we now? Where are we going? Int J Nurs Stud. 2021 Apr;116:103402.

13. Tamis-Holland JE, Lu J, Korytkowski M, Magee M, Rogers WJ, Lopes N, et al. Sex differences in presentation and outcome among patients with type 2 diabetes and coronary artery disease treated with contemporary medical therapy with or without prompt revascularization: a report from the BARI 2D Trial (Bypass Angioplasty Revascularization Investigation 2 Diabetes). J Am Coll Cardiol. 2013 Apr 30;61(17):1767–76.

14. Hendriks SH, van Hateren KJJ, Groenier KH, Houweling ST, Maas AHEM, Kleefstra N, et al. Sex Differences in the Quality of Diabetes Care in the Netherlands (ZODIAC-45). PloS One. 2015;10(12):e0145907.

15. Lee CS, Riegel B, Driscoll A, Suwanno J, Moser DK, Lennie TA, et al. Gender differences in heart failure self-care: a multinational cross-sectional study. Int J Nurs Stud. 2009 Nov;46(11):1485–95.

16. Brera AS, Arrigoni C, Dellafiore F, Odone A, Magon A, Nania T, et al. Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences. Med Lav. 2021 Aug 26;112(4):306–19.

17. Caruso R, Rebora P, Luciani M, Di Mauro S, Ausili D. Sex-related differences in self-care behaviors of adults with type 2 diabetes mellitus. Endocrine. 2020 Feb;67(2):354–62.

18. Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev. 2016 Jun;37(3):278–316.

19. Gale EA, Gillespie KM. Diabetes and gender. Diabetologia. 2001 Jan;44(1):3–15.

20. Lyons MR, Peterson LR, McGill JB, Herrero P, Coggan AR, Saeed IM, et al. Impact of sex on the heart’s metabolic and functional responses to diabetic therapies. Am J Physiol Heart Circ Physiol. 2013 Dec 1;305(11):H1584-1591.

21. Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Ladwig K-H, et al. Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups. J Diabetes Complications. 2015 Mar;29(2):203–11.

22. Kacerovsky-Bielesz G, Lienhardt S, Hagenhofer M, Kacerovsky M, Forster E, Roth R, et al. Sex-related psychological effects on metabolic control in type 2 diabetes mellitus. Diabetologia. 2009 May;52(5):781–8.

23. Caruso R, Rebora P, Dellafiore F, Fabrizi D, Riegel B, Ausili D, et al. Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence. Acta Diabetol. 2019 Feb;56(2):151–61.

24. Caruso R, Rebora P, Luciani M, Di Mauro S, Ausili D. Sex-related differences in self-care behaviors of adults with type 2 diabetes mellitus. Endocrine. 2020 Feb;67(2):354–62.

25. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. 2006.

26. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372(71).

27. Kacem A, Mayr P. Analysis of Footnote Chasing and Citation Searching in an Academic Search Engine. ArXiv170702494 Cs [Internet]. 2017 Sep 23

28. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. JBI Man Evid Synth [Internet]. 2020.

29. Ausili D, Barbaranelli C, Rossi E, Rebora P, Fabrizi D, Coghi C, et al. Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory. BMC Endocr Disord. 2017 Oct 16;17(1):66.

30. Caruso R, Arrigoni C, Magon A, Pittella F, Dellafiore F, Grugnetti AM, et al. Health Determinants in Italian Type 2 diabetes mellitus (T2DM) patients: a critical gender differences analysis. J Res Gend Stud. 2017;7(2):93.

31. Yin J, Yeung R, Luk A, Tutino G, Zhang Y, Kong A, et al. Gender, diabetes education, and psychosocial factors are associated with persistent poor glycemic control in patients with type 2 diabetes in the Joint Asia Diabetes Evaluation (JADE). J Diabetes. 2016 Jan;8(1):109–19.

32. Choi JS, Kim BH, Chang SJ. Gender-Specific Factors Influencing Diabetes Self-Care Behaviors and Health-Related Quality of Life Among Older Adults With Type 2 Diabetes in South Korea. Res Gerontol Nurs. 2015 Aug;8(5):231–9.

33. Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Social factors and barriers to self-care adherence in Hispanic men and women with diabetes. Patient Educ Couns. 2015 Jun;98(6):805–10.

34. Boonsatean W, Carlsson A, Dychawy Rosner I, Östman M. Sex-related illness perception and self-management of a Thai type 2 diabetes population: a cross-sectional descriptive design. BMC Endocr Disord. 2018 Dec;18(1):5.

35. Vaccaro JA, Huffman FG. Gender Differences in Medical Advice and Health Behavior of Obese African Americans With and Without Type 2 Diabetes. Am J Mens Health. 2012 Sep;6(5):383–94.

36. Shrestha AD, Kosalram K, Gopichandran V. Gender difference in care of type 2 diabetes. JNMA J Nepal Med Assoc. 2013 Mar;52(189):245–50.

37. Misra R, Lager J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complications. 2009 Jan;23(1):54–64.

38. Avedzi HM, Mathe N, Storey K, Johnson JA, Johnson ST. Examining sex differences in glycemic index knowledge and intake among individuals with type 2 diabetes. Prim Care Diabetes. 2018 Feb;12(1):71–9.

39. Vitale M, Masulli M, Cocozza S, Anichini R, Babini AC, Boemi M, et al. Sex differences in food choices, adherence to dietary recommendations and plasma lipid profile in type 2 diabetes – The TOSCA.IT study. Nutr Metab Cardiovasc Dis. 2016 Oct;26(10):879–85.

40. Naicker K, Øverland S, Johnson JA, Manuel D, Skogen JC, Sivertsen B, et al. Symptoms of anxiety and depression in type 2 diabetes: Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study. Psychoneuroendocrinology. 2017 Oct;84:116–23.

41. Chiu C-J, Wray LA. Gender Differences in Functional Limitations in Adults Living with Type 2 Diabetes: Biobehavioral and Psychosocial Mediators. Ann Behav Med. 2011 Feb;41(1):71–82.

42. Taru C, Tsutou A, Nakawatase Y, Usami M, Miyawaki I. Gender Differences of Dietary Self-Management Behavior Affecting Control Indices in Type II Diabetes. :15.

43. Tokunaga-Nakawatase Y, Taru C, Tsutou A, Nishigaki M, Miyawaki I. Self-management behavior concerning physical activity of Japanese type 2 diabetes patients, characterized by sex, daily energy intake and body mass index. Diabetol Int. 2019 Jul;10(3):206–12.

44. Aghili R, Ridderstråle M, Kia M, Ebrahim Valojerdi A, Malek M, Farshchi A, et al. The challenge of living with diabetes in women and younger adults: A structural equation model. Prim Care Diabetes. 2017 Oct;11(5):467–73.

45. Rossi MC, Lucisano G, Pintaudi B, Bulotta A, Gentile S, Scardapane M, et al. The complex interplay between clinical and person-centered diabetes outcomes in the two genders. Health Qual Life Outcomes. 2017 Jan;15(1):41.

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