Women Are Less Likely to Receive Recommended Diabetes Care From PCPs
Primary care physicians order less diabetes and cholesterol tests for women than men
Primary care physicians (PCPs) are less likely to order recommended diabetes tests and statins for women than for men—even when these women had a history of at least one diabetic complication, according to an observational study involving a cohort of more than 4,800 patients with diabetes from a managed care organization. The findings were reported in the Journal of Diabetes Research.
Women in this cohort were less likely than men to receive guideline-concordant testing for low density lipoprotein (LDL) cholesterol (adjusted odds ratio [AOR], 0.73), achieve a target LDL of <130 mg/dL (AOR, 0.70), and receive a statin prescription when warranted (AOR, 0.61). On the other hand, women were more likely than men to achieve their target hemoglobin A1c goal (AOR, 1.19).
Gender differences also were found in self-care behaviors with women being significantly less likely to exercise three times per week (55% vs 64%, P<0.001). In contrast, men with diabetes were less adherent to recommended diet, home glucose monitoring, and foot care compared with women.
“We found the same patterns of gender disparities in diabetes process of care measures and diabetes self-care in a subset of subjects with known diabetic complications—that is, patients who should have been recognized as high risk for further diabetic complications,” said co-author Margaret Yu, MD, postdoctoral nephrology fellow at the University of Washington, Seattle.
“In this cohort, PCPs were not aggressive with screening for dyslipidemia, even in patients who had a complication, which is very troubling,” commented John E. Anderson, MD, President, Medicine & Science of the American Diabetes Association. However, the findings are based on one cohort from the northwest part of the United States and may not be generalizable to the rest of the United States, he said, adding that this fact doesn’t diminish the importance of the study. In addition, he noted that there were more similarities than dissimilarities between care given to men and women in this study.
Possible Causes of Gender Disparities
“We suspect that gender disparities in diabetes process of care measures and self-care behaviors may be a result of both patient and provider factors,” Dr. Yu said. “Women with diabetes may underestimate their risk for diabetic complications and either fail to inquire about or decline routine diabetes care. Furthermore, there is evidence that men and women have different perceptions regarding the benefit of self-care. Health care providers may also perceive diabetic women to have a lower risk of cardiovascular disease and end-organ complications compared to men, which may lead to less aggressive diabetes monitoring and treatment in women. However, additional studies are needed to really find out what is behind these gender disparities,” she said.
“The fact that they didn’t get as many women to LDL goal is difficult for me to interpret because we know that women with diabetes have a 10-year clustering of other cardiovascular risk factors—eg, higher LDL cholesterol and triglyceride levels, and tend to have higher systolic blood pressure,” Dr. Anderson said. “Was the fact that PCPs didn’t get women to LDL goal reflective of the decreased use of statin therapy or was it that these patients are a little more difficult to get to goal? While I don’t think you can really answer that question with this study, data from this study and previous studies suggest that LDL screening for women with diabetes who do or do not have a complication needs to be at the forefront of a PCP’s understanding,” he said, adding that women with diabetes have a higher risk for cardiovascular events and worse outcomes from these events.
“We hope that these findings will raise awareness of the ongoing gender disparities in diabetes care and provide primary care providers with an opportunity to improve diabetes care not only for women, but for men as well. These results highlight areas of diabetes care that are easily modifiable and may be important in reducing long-term complications of diabetes,” Dr. Yu concluded.