Even with targeted programs, gender differences with diabetes care remain

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There are major gender differences in healthcare utilization of type 2 diabetes patients in Germany despite a high rate of participation in disease management programs to treat diabetes mellitus in this region, according to a cohort study in the July issue of the American Journal of Managed Care.

Heike U. Krämer, MSc, from the division of clinical epidemiology and aging research at the German Cancer Research Center in Heidelberg, Germany, and colleagues evaluated 1,146 patients with type 2 diabetes in southwest Germany recruited between October 2008 and March 2010 in the primary care setting.

In this cohort of patients, the researchers found a higher cardiovascular comorbidity in men, whereas women suffered more often from depression, irrespective of quality of glycemic control and self-reported general health status. Analyzing the healthcare utilization in outpatient and inpatient care settings, they found no or marginal differences between men and women regarding the number of general practitioner and medical specialist appointments, the number of prescribed medications, hospitalization and rehabilitation. However, after stratifying for glycemic control, in the group of patients with poor glycemic control, men had significantly lower numbers of general practitioner appointments and numbers of prescribed medications than women.

After bivariate analyses, the researchers used multivariate Poisson and logistic regression models to estimate the effect of sex on the number of general practitioner and medical specialist appointments, prescribed medications, hospitalizations and inpatient rehabilitations, with additional consideration of glycemic control levels. Poor glycemic control was defined as glycated hemoglobin at least 7.5 percent.

In total, 905 participants had acceptable glycemic control and 237 participants had poor glycemic control. Poor glycemic control was more prevalent in men than in women (23 percent vs. 18 percent). Bivariate analyses among participants with poor glycemic control showed significantly fewer general practitioner and medical specialist appointments, a lower number of medications and longer rehabilitation stays in men than in women.

Multivariate regression analyses among participants with poor glycemic control confirmed statistically significant gender differences for general practitioner appointments and number of prescribed medications for men compared with women. Gender differences regarding inpatient care were less evident.

Krämer et al noted that the cross-sectional analyses of baseline data of a large cohort study of patients with type 2 diabetes mellitus of whom 80 percent were enrolled in a type 2 diabetes-specific disease management program were performed to investigate gender differences in healthcare utilization. Gender differences regarding inpatient care were far less evident.

“Health authorities should concentrate on gender-specific healthcare differences being still inherent in disease management programs to diabetes mellitus in order to improve quality of healthcare,” the researchers wrote.

The study authors recommended that future research should focus attention on gender-specific approaches to healthcare delivery to improve quality and access to care. “Examples might include introducing gender-focused diabetes treatment and training programs offered by statutory health insurances. Future research should focus on gender differences in the access to healthcare and its potential effect on diabetes progression,” they wrote.