Gender-Based Disparities in Subjective Versus Objective Glycemic Control in Individuals with Type 1 Diabetes

Abstract

Objective: Hypoglycemia management requires a high degree of risk estimation of people with type 1 diabetes. Wrong perception in diabetes management can hamper accurate assessments of hypo- and hyperglycemia risks. It is unknown whether men and women differ in their perception of glycemic control parameters, and how this relates to actual glycemic control. Therefore, we compared 14-day continuous glucose monitoring (CGM) and self-rated glycemic control between men and women with type 1 diabetes.Research Design and

Methods: A subjective to objective diabetes regulation-index was calculated by formulating a ratio between time spent in target glycemic range (in tenth percentiles, TIR; 3.9-10.0 mmol/L) and self-rated glycemic control (on a scale of 0-10 in 488 participants (36.5% male, age 41.0±14.0years). Next, we formulated a hypoglycemia-estimation-index with CGM assessed hypoglycemia and self-reported hypoglycemia (both events per week).

Results: Men and women had similar TIR (66.0% [IQR 52.0- 80.0] vs. 66.0% [51.0-80.6], p=0.78) and HbA1c (54.3±13.2 vs. 56.2±11.5mmol/mol, p=0.08). However, on average men rated their diabetes management significantly higher than their objective TIR (31%, p <0.001) whereas women rated slightly below their TIR (3%, NS). Men and women reported similar numbers of hypoglycemic events, while CGM revealed men had more time below range, longer hypoglycemia duration (76.7±73.0 vs 64.3±50.9 min, p=0.03) and experienced more frequent hypoglycemic events compared to women (3.0 [1.0-6.0] vs. 3.0 [1.0-5.0] events/7 days, p=0.046). These discrepancy in diabetes regulation indexing remained significant even after adjustment for a various confounders.

Conclusion: Men overestimate their diabetes management relative to their TIR and underestimate their frequency of hypoglycemia, which could have significant health implications. Our results highlight gender differences in perception and the importance of CGM in improving the accuracy of risk management in diabetes care.

Funding: This research was supported by a DNF DON grant 2020, number 2020.10.002 on which C.F.S. and N.M.H. are appointed. P.S is supported by a ZONMW VIDI grant 221E011. N.M.H. is supported by a Senior Clinical Dekker grant by the Dutch Heart Foundation (grant number 2021T055) and a ZONMW-VIDI grant (09150172210019). M.N. is supported by a personal ZONMW-VICI grant 2020 (09150182010020) and an ERC-Advanced grant 2023 (101141346).

Declaration of Interest: C.F.S., PS, PdG, E.R., S.S., S.M. J.H.D. have no conflicts of interest to disclose, B.R. have no conflicts of interest in relation to current manuscript. M.N. is in the Scientific Advisory Board of Caelus Pharmaceuticals and Advanced Microbiome Interventions, the Netherlands. DVR has acted as a consultant for and received honoraria from Boehringer Ingelheim-Eli Lilly Alliance, Merck, Sanofi, and AstraZeneca, and has received research operating funds from Boehringer Ingelheim-Lilly Diabetes Alliance, AstraZeneca, and Merck. All honoraria are paid to his employer. N.M.H. has received an honorarium from Boehringer Ingelheim and Novo Nordisk.

Ethical Approval: Ethical approval was obtained from the local medical ethics committee of the Amsterdam University Medical Centre (Dutch central commission of human research number: NL73189.018.20) in accordance with the declaration of Helsinki.

Keywords: Type 1 diabetes, time in range, gender differences, diabetes management