Diabetes and Its Related Complications: Sex and Gender ...

Diabetes and Its Related Complications: Sex and Gender ...

Diabetes and Its Related Complications: Sex and Gender Considerations Paula Rochon, MD, MPH Lead, Womens Xchange Vice President, Research, Womens College Hospital Sex and Gender Goal Group Paula Rochon, MD, MPH, FRCPC Lead, Womens Xchange Vice President, Research, Women's College Hospital Robin Mason, PhD Scientific Lead, Womens Xchange

Scientist, Womens College Research Institute Paula Harvey, BMBS, PhD, FRACP Scientist, Womens College Research Institute Director, Cardiovascular Research Program, Womens College Hospital Amy Hoang-Kim, PhD Postdoctoral Fellow, Womens Xchange Nousin Hussain, BSc Research Assistant, Womens Xchange Consider Mrs. Smith 80 year old woman, widowed, living alone in rural area, independent but still involved

with family Type 2 diabetes, takes insulin Family members notice more forgetful, questioning dosage of insulin, trouble reading dosage People not coming in regularly to check in Mrs. Smith found unresponsive Consider Julie 16 year old female recently diagnosed with Type 1 Diabetes Julie and mom are increasingly at odds; mom tries to monitor what

Julie eats, her glucose testing, insulin administration Julie had lost weight and is upset that she is now regaining weight (Camp Sweeney; Diabetes Camp 2011) What is Sex? Sex refers to the biological & physiological characteristics that distinguish females from males. (APA, 2012)

Sex Matters in Research 40 million prescriptions in the U.S. per year of Ambien, a sleeping pill In 2013, the FDA cut the suggested dose of Ambien in half for women Women metabolize Ambien differently, reaching maximum blood levels 45% higher than those of men. Women are more likely to be left the next morning with levels of the drug in their bodies that could impair driving an automobile. (Farkas et al, 2013)

Beyond Sex What is Gender? Gender refers to socially constructed roles, expectations, relationships, and other traits (APA, 2012) Cis Gender Born Female Born

Male The Gender Spectrum Transgender (APA 2015; Meier & Labusk, 2013) Examples of Gender+ Variables Gender+ Relationship Status

Caregiving Roles Income Geographic Residence Social Support Revisiting Mrs. Smith More older women than men More women live alone than men; widowed, poorer (i.e. lack of pension) The average age of patients with dementia is 84 years, and 75% are female

Living in rural area affects social support Caregiving roles shift from providing care to needing care (Prince et al, 2013) Revisiting Julie Adolescent girls may use insulin omission to achieve weight control or weight loss (Daneman et al, 2002) Women with type 1 diabetes are 2.4 times more likely to develop an eating disorder

than those without diabetes (Morrison, 2012) Mothers are the primary caregivers in most families; many have to rearrange work schedules or leave work to care for their child (Whittemore et al, 2012) Mothers report greater burden related to medical treatment and more emotional distress than fathers (Haugstvedt et al, 2011) (Camp Sweeney; Diabetes Camp 2011) Sex, Gender and Diabetes: The Gap in Research

There is little research specific to sex and gender in diabetes Little exploration in differences in attitude and behaviour Studies mostly cross-sectional, not longitudinal Small sample size, higher SES groups, biased questionnaires (not gender sensitive) (Siddiqui et al, 2013) Sex, Gender and Diabetes Quality of diabetes control worse in women (Pond et al, 1996) Women make greater use of diabetes services and have a larger support network (Green, 1990)

Women have higher expectations of the outcome of selfmanagement activities, and a higher perceived level of support from health care professionals (Gucciardi et al, 2008) Women with diabetes have a significantly higher risk of coronary artery disease and higher mortality from cardiovascular disease (Pilote, 2007) Women more likely to have depressive symptoms along with diabetes (Blazer et al, 2002) Better Research with Sex & Gender Integration of Sex and

Gender Short Term Outcomes Understanding differences in outcomes of health interventions and health service provision Medium Term Outcomes Targeted policies, programs and health care delivery models Long Term Outcomes Improved health for all When to Integrate Sex and

Gender? Sex & gender should be considered from the beginning and integrated throughout all stages of the research process Research Question Development Research Design and Methods Data Analysis

Data Reporting Knowledge Translation Conceptualization Completion How to Integrate Sex and Gender in Your Research Vision, rationale and added value Do you have a clear vision of the expected sex and

gender outcomes? Has explicit consideration been given to achieving equitable health impacts across diverse patient subgroups? Strength of the team Sex and gender champions Appropriate role for champions (i.e. integrated in research process) (CIHR Institute for Gender and Health, Sex and Gender Checklist) 17 How to Integrate Sex and

Gender in Your Research Quality and appropriateness of research approach Literature Review (known sex/gender differences or lack thereof in research area) Research Question (identifying or explaining sex and gender differences) Study Design and Methods (inclusion/exclusion criteria, recruitment strategies, outcome measures, data collection tools) Analysis and Reporting (adequate sample size to show SG differences, report negative findings) (CIHR Institute for Gender and Health, Sex and Gender Checklist) Collecting Sex & Gender Data:

Emerging Agreement on Questions to Ask Q1. What sex were you assigned at birth, meaning on your original birth certificate? Male Female Other (Please Specify) Q2. How do you currently describe your gender? Woman Man Bigender Trans man Trans woman Crossdresser Genderqueer

Agender Gender fluid 2-spirited You dont have an option that applies to me. I identify as ... (please specify) The third question may be asked only of those who indicated a current gender identity different than their birth-assigned sex. If so it can be forward-filled to code cisgender participants as living in their identified (and birth-assigned) sex/gender. Q3. What gender do you currently live as in your day-to-day life? As a man As a woman Sometimes as a man, sometimes as a woman Something other than as a man or woman

Adapted from Du Mont, J., & Macdonald, S. 2017 Consideration of Sex & Gender in Research 1 Not Considered 2 Cursory Consideration (Incomplete and/ or Unclear)

3 Considered (Not compelling, not justified) 4 Full Consideration (Not integrated) Consult the Sex and Gender Goal Group and

Facilitators 5 Comprehensive Integration Womens Xchange Resources for Sex & Gender Integration Subtitle Revisiting Mrs. Smith and Julie What sex and gender considerations do we need to take into account when doing this research?

Camp Sweeney; Diabetes Camp 2011; https://creativec ommons.org/licenses/by/4.0/legalcode 23

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