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Personal Care Approach Aids Glycemic Control in Diabetic Women

Posted: Monday, May 22, 2006

Women with diabetes whose medical care includes quarterly consultations with their doctors and individualized goal setting tend to develop lower glycosylated hemoglobin levels (A1C) than those who receive routine care.

That comes from the data from the Danish Diabetes Care in General Practice (DCGP) trial. Men, however, don't seem to benefit from this approach, Danish report in the May issue of Diabetes Care.

The trial focused on health care provider behavior, such as evaluating treatment with patients and emphasizing the importance of diet and exercise in controlling their disease, Dr. Anni B. S. Nielsen and colleagues at the University of Copenhagen point out.

The physicians themselves underwent a brief training program and received feedback on individual patients.

After 6 years, subjects in the intervention group had better glycemic control than did those in the routine care group.

Dr. Nielsen and colleagues analyzed the effect of the intervention on knowledge, attitudes, lifestyle, and social support based on questionnaire responses. They also investigated whether the structured personal care exerted the same effect regardless of patient gender.

Their analysis included 459 subjects randomly assigned to structured personal care and 415 assigned to routine care.

After approximately 6 years, women in the intervention group had A1C values of 8.4%, versus 9.2% in the routine care group.

After adjusting for baseline A1c, physician, age, diabetes-related consultations, diabetes duration, BMI, diet, medication and physical exercise, the ratio between A1C in routine care and structured personal care at the end of the study was 1.10 (p < 0.0001).

For men, corresponding A1C values were 8.5 and 8.9, with an adjusted ratio of 1.02 (p = 0.27).

The team found that women in the structured care group had more diabetes-related consultations than the control group of women, whereas men were more apt to have fewer consultations if they were allocated to structured care.

Overall, women exercised less, ate a healthier diet, and showed more adaptive attitudes toward their disease compared with men, but women reported less social support.

"It may be necessary to make an extra effort to optimize the treatment of men," the investigators write. Moreover, they note that caregivers should be aware "that women may be more inclined to comply with regular follow-up and to perceive their illness as unproblematic."

Source: Diabetes In Control: Diabetes Care 2006;29:963-969