Personally tailored diabetes care reduces mortality in women but not men

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Personally-tailored care reduces mortality in women with type 2 diabetes, but not in men, according to a study from the University of Copenhagen, Denmark.

This study followed up with patients in the Danish Diabetes Care in General Practice trial, which ran from 1989 to 1995. This trial focused on the treatment intervention of structured personal care in patients with newly diagnosed type 2 diabetes. In the intervention group, doctors stressed the importance of healthy diet and of exercise, and delayed the use of pharmaceutical intervention until the effects of the original intervention could be assessed. Patients were given individual targets that were reviewed quarterly. GPs in the routine care group were free to choose any treatment and to change it over time, as they normally would.

After 6 years of tailored treatment there no effect was seen on mortality and other pre-defined non-fatal outcomes. However, the observed effect of structured personal care on reducing glycated haemoglobin (Hba1c) measured 6 years after diagnosis was present only in women.

The follow up study, by Marlene Krag, The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark, and colleagues, followed up with the participants of the original study for thirteen years.

In this new study, the authors followed up the participants of the original study for 13 years (from 1995–2008). This analysis comprises the 970 out of the original 1,381 patients who survived and were re-examined at the end of 6 years of intervention in 1995. Of these, 478 were women and 492 were men.

The data to the end of 2008 showed that women given structured personal care were 26% less likely to die of any cause and 30% less likely to die of a diabetes-related cause than women given routine care. Women given the personal care intervention were also 41% less likely to suffer a stroke, and 35% less likely to experience any diabetes-related endpoint.

However, the findings for stroke and any diabetes-related outcome were not statistically significant. None of these differences were seen between the personal care and routine care points in men, but the differences between genders were only statistically significant for all-cause mortality and diabetes-related death.

Discussing the different results for women versus men, the authors say “Structured personal diabetes care could provide women with significant attention and support and thus provide an incentive to treatment adherence. Women accept disease and implement disease management more easily, which might affect long-term outcomes. Masculinity may be challenged by diabetes, demanding daily consideration and lifestyle changes. The structured approach could conflict with men’s tendency to trust self-directed learning instead of self-management.”

They conclude “We propose that the improved outcomes in women may be explained by complex social and cultural issues of gender. There is a need to further explore the gender-specific effects of major intervention trials in order to rethink the way we provide medical care to both men and women, so that both sexes benefit from intensified treatment efforts.”

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