In the United States more than half of the 15.7 million people with diabetes are women, according to the CDC. Whether they suffer from type 1, type 2 or gestational diabetes, women present unique disease-management challenges for clinicians.
One-in-three women with diabetes will die from heart disease compared to one in nine women without the condition. Those who experience myocardial infarction are less likely to survive than their male counterparts, and if they do, they are more likely to report reduced quality of life. In fact, women with diabetes generally have shorter life spans than women without the disease, and are more likely than men to lose their eyesight.
Additionally, women with diabetes often have fewer years of education, lower income and are unemployed at higher rates compared with men who have the disease. They often face more severe complications from uncontrolled diabetes, and might also have other conditions, such as eating disorders or depression that can complicate treatment.
Pregnant women with diabetes have a higher risk for miscarriage and birth defects. Furthermore, children born to mothers with diabetes are more likely to develop obesity and diabetes themselves, according to the National Diabetes Education Program (NDEP).
Clinicians treating women with diabetes or working to prevent women from developing the condition need to consider the unique risk factors in this population and the barriers that may exist when it comes to treatment and education.
The first step to helping a patient successfully manage her diabetes is education. Each patient ultimately determines how well her diabetes is managed by deciding whether to make diet and lifestyle changes.
Clinicians should ensure that all patients diagnosed with diabetes are educated to self-manage the condition. This education should be ongoing as needed, according 2011 Clinical Practice Recommendations from the American Diabetes Association (ADA), and should not only include basic information about nutrition and glucose control, but also psychosocial issues. Patients who are unhappy or stressed may not manage their disease properly.1
Clinicians should regularly assess the psychological health of patients and inquire about their social circumstances as part of diabetes management. Some key items clinicians should ask about when working with patients include:
- Personal attitude about diabetes
- Expectations related to managing the disease
- Emotional health
- Quality of life issues
- Financial, social and emotional resources
- Psychiatric history
Clinicians always should be on the lookout for depression, anxiety, eating disorders, and stress-related and cognitive issues, according to the ADA guidelines.
Encourage and support lifestyle changes
One of the most powerful ways to control diabetes is through diet and exercise, but women with diabetes may need help and support to make these changes. Clinicians should encourage the following behaviours in women with diabetes to help reduce their risk for heart disease:
Stick to a diet that incorporates at least 14 grams of fiber daily for every 1,000 calories consumed;
- Focus on cholesterol-reducing high-fiber foods such as oatmeal, whole-grain breads, cereals, dried beans, fruits and vegetables;
- Reduce intake of saturated fats, trans fats and cholesterol;
- Exercise at least 30 minutes on most days;
- Lose weight.
Working with a registered dietician to develop a medical nutrition therapy plan may help women with prediabetes or diabetes achieve these goals. Professionals in this area not only educate patients, but also help them come up with tailored strategies that fit their lifestyles.
Women with diabetes should focus on creating meal plans that work with their own schedules. For example, a busy professional who gets home from work late at night might be more likely to stick with a plan that includes quick-fix meal options. Refer patients to the ADA website for useful tools that can help them choose foods, plan meals and even track foods.
Weight management is another critical step in helping women live well with diabetes. Even if a patient cannot lose weight, exercising still improves heart health. The Joslin Diabetes Center in Boston recommends that patients with diabetes engage in moderate exercise for at least 30 minutes on most weekdays. Provided they are healthy enough, ADA guidelines recommend clinicians encourage patients to perform resistance training three days a week.
Protect the heart
Heart disease is a primary concern for women with diabetes, as the condition itself predisposes women to heart problems. As many as 90 percent of women with diabetes also have other risk factors including smoking, high cholesterol or uncontrolled BP that make heart disease even more likely.
The American Heart Association recommends target LDL cholesterol levels remain below 100 mg/dl and less than 70 mg/dl in patients with heart disease. Clinicians should consider statins for patients who are not successful in improving their cholesterol with lifestyle interventions, the ADA recommends.
Target BP should remain lower than 130/80 mm Hg. Controlling BP is not only good for the heart, it can also protect a woman’s eyesight. Keeping BP at optimal levels can reduce the risk of diabetic retinopathy.