Sex-related differences in determinants of self-care behaviors in adults with type 1 diabetes mellitus

BACKGROUND: Sex-related differences in determinants of self-care in adults with type 1 diabetes mellitus (T1DM) were not investigated before. Knowing this could allow clinicians to better identify risk factors for inadequate self-care in male and female T1DM patients. The aim of this study was to assess sex-related differences in self-care behaviors and their determinants in adults with T1DM. METHODS: Secondary analysis from a multicenter cross-sectional study on a sample of 181 adults with T1DM. Clinical and socio-demographic data were collected by medical records. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. Self-care confidence was scored also for its internal dimensions: task-specific self-care confidence and persistence self-care confidence. A standardized 0-100 score was used for each scale where a score <70 means inadequate self-care. Multiple logistic regression models were run to identify clinical and socio-demographic determinants of self-care, splitting the sample into males (N.=70) and females (N.=111). RESULTS: Inadequate self-care confidence was associated with inadequate self-care maintenance in both males (OR adjusted = 14.05; 95% CI: 1.017-19.423; P=0.049) and females (OR adjusted = 4.69; 95% CI: 1.285-17.118; P=0.019), but the odds was higher in men. Inadequate self-care confidence predicted inadequate self-care monitoring in men (OR adjusted = 14.04; 95% CI: 1.144-17.215; P=0.039) but not in woman (OR adjusted = 2.69; 95% CI: 0.751-9.616; P=0.129). Inadequate task-specific self-care confidence was associated to inadequate self-care management in males (OR adjusted = 1.14; 95% CI: 1.11-1.53; P=0.016) and females (OR adjusted = 1.08; 95% CI: 1.07-1.15; P=0.054), but the odds was higher in males. CONCLUSIONS: Although self-care confidence is known to be the most important determinant of self-care in both male and female T1DM patients, it seems to have a higher influence in men. Future studies should investigate psychological and social factors mediating the effect of self-care confidence on self-care behaviors of male and female adults with T1DM.