Gender Differences in Treatment Burden and Care Sustainability Among Adults Living With Diabetes

Objective Women carry disproportionate shares of caregiving and other life demands that may compound the work of diabetes self-management. We sought to examine gender differences in overall and digital treatment burden and their key contributors. Research Design and Methods Cross-sectional analysis of two cohorts of adults with type 1 or type 2 diabetes attending outpatient endocrinology visits who completed the Treatment Burden Questionnaire Plus Digital (TBQ+D) (n=472). Multivariable regression estimated gender differences in overall and digital treatment burden, ability to live a normal life, and sustainability of current self-care effort, adjusting for age, diabetes type, insulin intensity, HbA1c, and cohort. Item-level analyses identified contributors to observed differences. Results Compared to men, women reported higher median overall treatment burden (33 vs 20, adjusted mean difference 10.6 points, 95% CI 5.1-16.3; p<.0001) and digital treatment burden (13 vs 7, adjusted mean difference 3.5 points, 95% CI 1.1-6.1; p=.009). They also had higher odds of not living a normal life (OR 1.77, 95% CI 1.18-2.67; p=.006) and difficulty sustaining current self-care efforts indefinitely (OR 2.01, 95% CI 1.10-3.66; p=.023). Digital burden differences were concentrated in annoyance, precautions, and time and effort required to use digital medicine tools, whereas contributors to differences in overall burden varied, with relationships, self-monitoring, and injections contributing most. Conclusions After adjusting for treatment intensity and other factors, women living with diabetes were twice as likely to be overwhelmed by diabetes care than men. Their greater vulnerability to treatment burden demands healthcare service redesign and individualization of plans of care that minimally disrupt patients' and caregivers' lives.