Sex Disparities in Diabetes Process of Care Measures and Self-Care in High-Risk Patients

Patients with chronic diabetic complications experience high morbidity and mortality. Sex disparities in modifiable factors such as processes of care or self-care activities have not been explored in detail, particularly in these high-risk patients. Sex differences in processes of care and self-care activities were assessed in a cross-sectional analysis of the Pathways Study, an observational cohort of primary care diabetic patients from a managed care organization ( ). Compared to men, women had decreased odds of dyslipidemia screening (adjusted odds ratio (AOR) 0.73, 95% CI 0.62–0.85), reaching low-density lipoprotein goal (AOR 0.70, 95% CI 0.58–0.86), and statin use (AOR 0.69, 95% CI 0.58–0.81); women had 19% greater odds of reaching hemoglobin A1c <7% (95% CI 1.02–1.41). There were no sex differences in hemoglobin A1c testing, microalbuminuria screening, or angiotensin-converting enzyme inhibitor use. Women were less likely to report regular exercise but had better adherence to healthy diet, glucose monitoring, and self-foot examination compared to men. Patterns of sex differences were consistent in subjects with diabetic complications. Significant sex disparities exist in diabetes process of care measures and self-care, even amongst patients known to have chronic diabetic complications. 1. Introduction In the United States, diabetes mellitus affects 26 million people [1] and its chronic vascular complications are associated with significant morbidity [2, 3], disability [4], and mortality [5]. Chronic complications from diabetes account for approximately $58 billion in excess medical expenditures per year [3]. Common risk factors for microvascular and macrovascular diabetic complications include age, duration of diabetes [6], hyperglycemia [7–9], and high blood pressure [10]; therefore multiple complications commonly develop in the same patient [5, 6]. In addition to the management of cardiovascular risk factors, prevention of diabetes complications also involves diabetes self-care such as diet, exercise, self-monitoring of blood glucose, and self-foot examination [11]. As a result, the American Diabetes Association (ADA) has established clinical practice guidelines regarding standard diabetes care, which include recommendations for diabetes process of care measures (frequency of laboratory testing, clinical goals, and recommended medications) and self-care [11]. A few studies have suggested that adherence with these diabetes clinical practice guidelines varies by sex. Women with diabetes have been reported to have worse blood pressure, lipid, and