While these investigations do not provide a clear picture of the differences regarding cardiovascular risk between men and women with T2DM, they suggest that men with T2DM have a lower risk of nonfatal and fatal CVD and stroke than do women with T2DM. However, the lower risk seen in men may be affected by the cardiovascular endpoints measured and the presence of microvascular disease. Possible independent risk factors for CVD in men with T2DM include hypertension, poor glycemic control, and low HDL-C.
Risk factors that place MR at greater risk for CVD compared with a woman with T2DM and therefore serve as key treatment targets include:
- Hypertension—although controlled (126/78 mm Hg) with hydrochlorothiazide and lisinopril
- Poor glycemic control—A1C, 7.8% (eAG, 177mg/dL)
- –Increase physical activity—refer for knee rehabilitation
- –Intensify glucose-lowering therapy by adding an additional glucose-lowering agent (eg, dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, thiazolidinedione, α-glucosidase inhibitor, sulfonylurea, glinide, or basal insulin)
- Microalbuminuria (45 mg urinary albumin/g creatinine)—encourage better adherence to lisinopril; monitor renal function
- Hypertriglyceridemia—initiate omega-3 fatty acid or extended-release niacin
Psychosocial Well-Being, Benefit of Self-Care, and Coping Strategies
Type 2 diabetes mellitus is a chronic disease with glycemic control largely determined by patient self-management, and the attitudes and beliefs of patients with T2DM are important factors to consider from diagnosis onward.23 There are important differences between men and women with T2DM regarding attitudes and beliefs. Published investigations provide some, although not entirely consistent, insight into these psychosocial differences between men and women with T2DM. These differences are summarized in TABLE 2 .24-32 Taking these differences into account when planning treatment and when communicating with and educating the patient is essential for improved patient self-management.
TABLE 2
Psychosocial and Coping Characteristics of Men with Type 2 Diabetes Mellitus (T2DM)24-32
Compared with women with T2DM, generally, men with T2DM:
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Key interventions for MR:
- Maintain a dialogue and enhance collaboration with MR
- Establish shared goals that are customized to incorporate MR’s personal goals
- Problem solve with MR to identify ways he can better integrate the diabetes self-care objectives of dietary changes and blood glucose self-monitoring into his daily life
- Emphasize that enhanced or greater disease control can be achieved by good self-management, including better adherence to the management plan
- Remind MR that T2DM is a progressive disease that requires intermittent medication adjustments to keep pace with its progression
- Build upon the belief that T2DM can be controlled by reminding MR that the disease was well controlled before his knee injury
- –Focus on the importance of rehabilitating his knee
- –Develop a rehabilitation plan
- Provide informational support regarding options for intensifying diabetes therapy (eg, dipeptidyl peptidase-4 inhibitor, thiazolidinedione, glucagon-like peptide-1 receptor agonist, sulfonylurea, or insulin)
- –Discuss MR’s needs and concerns, as well as barriers for each treatment option, particularly hypoglycemia and weight gain
- –Provide instruction or educational materials regarding injection devices
- –Involve the healthcare team, as appropriate
- Keep the treatment regimen as simple as possible; consider pill combinations where appropriate
Summary
The growing epidemic of T2DM requires intervention to assist patients who have been diagnosed to better manage the disease, to reduce the risk of developing the disease in those who have not yet been diagnosed, and to manage the associated complications. In addition to individualizing interventions based on a patient’s needs, concerns, and capabilities, taking gender into account is necessary. In otherwise healthy people, several independent factors appear to pose a higher risk of T2DM in men relative to women, including systolic hypertension, regular smoking, and alcohol intake ≥ 40 g/d. At the same time, men achieve greater risk reduction from moderate daily alcohol intake and a diet high in fish and seafood, low-fat dairy products, whole grains, and magnesium.
Once diagnosed with T2DM, men generally fare better than women regarding the risk for CVD; they also have a better prognosis after MI and a lower risk of death overall from CVD. Possible independent risk factors for CVD in men with T2DM that are especially important may include hypertension, poor glycemic control, and low HDL-C levels. Psychosocial complications, such as depression, are less likely in men with T2DM. However, men expend less effort coping, are less likely to utilize healthcare services, and are less informed about treatment options. Although men have a lower expectation of the benefit of self-management, they find support from family and friends more helpful than do women, but they are fearful of losing control of their disease.
Taking these gender differences into account should prove helpful as family care physicians work with men to reduce their risk of developing T2DM and in helping men diagnosed with T2DM to better self-manage their disease.