Issue: October 2017 - Women and diabetes
Section: The global campaign
Women with diabetes around the world
To support IDF’s World Diabetes Day 2017 theme of “Women and diabetes - Our right to a healthy future”, Diabetes Voice reached out to a variety of public or privately supported initiatives focused on improving the lives of women with diabetes around the world. In Singapore, we learn about the Ministry of Health’s determination to reduce the risk of diabetes for their population with an emphasis on women and their families, and in Italy, the Donna (Woman) Study Group explores potential gender differences in the quality of care in Italy, with special emphasis on cardiovascular risk factor targets and current treatments. In the US, we are introduced to a research team helping Latina women overcome barriers to diabetes self-management and prevention strategies, and we meet DiabetesSisters, a US nonprofit organisation who with online and in-person outreach provide support and education without judgment. Finally, in Saudi Arabia, we learn that women there are overcoming cultural barriers to access healthier lifestyles.
Singapore: Empowering women in the ‘war on diabetes’
Diabetes is a global health concern. In Singapore, 1 in 9 residents aged 18 to 69 have diabetes: of these, 1 in 3 persons are undiagnosed. Among those diagnosed, 1 in 3 have poor blood sugar control. Recognising this, Singapore’s Health Ministry declared ‘war on diabetes’ for a whole-of-nation effort to better prevent, screen and control diabetes.
Apart from managing their own risk factors for diabetes and other chronic diseases, women play an important role in their families as they can influence food and lifestyle choices at home. Singapore’s Health Promotion Board (HPB) works with grassroots and women’s groups to raise women’s awareness of diabetes. For example, HPB worked with the People’s Association Women’s Executive members to publish a collection of healthy recipes entitled “Healthy Kitchen, Healthy Women” and community talks on diabetes prevention and management were held to promote the initiative.
HPB’s efforts also extend to identifying persons with increased risk of developing diabetes later in life, and exploring ways to reduce this risk. One important group is women with gestational diabetes (GDM) who also have a higher risk of pregnancy complications. Close to 1 in 5 pregnant women in Singapore have GDM. GDM also places babies at higher risk for obesity and type 2 diabetes. In Singapore, routine GDM screening is offered to all pregnant women at public healthcare institutions. This is a shift from previous guidelines where only pregnant women at high risk were screened. Subsidies are also available to support eligible women in their regular screening for diabetes. Initiatives are being developed to anchor care in the community to facilitate holistic management and continuity of care for women post-delivery. Upstream, our preventive efforts include tackling the modifiable risk factors through various strategies. HPB in collaboration with KK Women’s and Children’s Hospital, developed a national mobile application allowing pregnant women to track their body mass index, blood pressure and blood sugar levels, and offered personalised health content.
Currently, screening for diabetes is recommended for Singaporeans 40 years and older. Later this year, we will launch a diabetes risk assessment (DRA) tool to assess the risk of undiagnosed diabetes in Singaporeans between 18 to 39 years old. This can help nudge those identified “at-risk” to attend screenings, and adopt habits to prevent diabetes. We want all younger women to use the DRA tool to assess their risk, and encourage their peers to follow suit.
We hope that this year’s World Diabetes Day theme – “Women and Diabetes” – will inspire women to take up a pivotal role in our ‘war on diabetes’ and help our loved ones lead healthier, happier lives.
Contributed by Dr Amy Khor, Senior Minister of State (Health and Environment & Water Resources), Singapore.
Italy: Gender differences in treating type 2 diabetes
The impact of diabetes on cardiovascular risk is particularly evident in women, who experience more major cardiovascular events, especially myocardial infarction, and higher mortality rate, even during pre-menopause. In Italy, a continuous improvement effort by a network of diabetes clinics has been implemented since 2006 under the aegis of the L’Associazione Medici Diabetologi (AMD), called the AMD Annals Initiative.
The AMD initiative, which includes approximately one-third of all diabetes outpatient clinics operating within the Italian national healthcare system, allows the monitoring of a large set of process and outcome indicators and the use of specific classes of drugs. The “Donna (Woman)” Study Group analyzed the AMD Annals data to explore potential gender differences in the quality of care in Italy, with particular regard to the achievement of cardiovascular risk factor targets and current treatments.
Overall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women. We found that gender disparities are less pronounced in Italy than in other countries, but they still exist, despite equal access to specialist care and universal coverage of healthcare costs. The achievement of targets for the major cardiovascular risk factors is systematically unfavorable to women with diabetes, who are more obese, often have a worse control of diabetes and worse lipid profile, and a higher frequency of reduced glomerular filtration rate, with a lower prevalence of microalbuminuria.
In the world, women with diabetes are systematically under-treated with drugs for cardiovascular risk factors, such as ASA, ACE-I, β-blockers, statins, and hypoglycemic agents, and this may explain the failure to achieve recommended targets. On the contrary, the Italian data do not confirm the trend by showing that there are no gender differences in the use of drugs: women and men are similarly treated with statins (40% both), but the difference in reaching the LDL target is still evident in all age-strata; women are more frequently treated with two or more antihypertensive drugs and the results in hypertension control is the same; women are more frequently treated with insulin or insulin and oral hypoglycemic drugs than men, but women were 11% more likely than men to have HbA1c levels >8.0% (64mmol/mol), mainly in more elderly patients.
Since men and women with type 2 diabetes receive the same “quantity and quality of care for their diabetes”, our data suggest that other biological, genetic and/or behavioral factors may underline these differences, and gender-specific studies are needed to explore these potential areas of intervention.
Contributors: Valeria Manicardi, Maria Chiara Rossi, Giuseppina.Russo, Patrizia Li Volsi, Nicoletta Musacchio, Domenico Mannino on behalf of the “Donna” Study Group” of AMD (Diabetologists’ Medical Association).
USA: Improving outcomes for Latina women
Although research studies have demonstrated that weight-loss through increased exercise and reduced calorie intake can help prevent or delay the development of type 2 diabetes and recent efforts on the national level have been aimed at diabetes prevention, these programs have yet to be effectively disseminated in Hispanic/Latino communities. Statistics from the American Diabetes Association suggest that the rates of diabetes are higher in Hispanic/Latina women than in the general population in the United States. Hispanic/Latina women tend to develop diabetes younger in the lifespan than non-Hispanics and are two to three times more likely to develop the disease. By age 70, more than 50 percent of these women have diabetes compared to around 10 percent for non-Hispanic whites.
Researchers at Wake Forest School of Medicine developed a group-based weight-loss intervention for diabetes prevention and have now adapted it for delivery in the local Latino community. The weight-loss intervention being tested is designed to be delivered in a community setting by a peer lay health advisor with support and training from healthcare professionals.
Beginning in 2014, 225 Hispanic/Latino participants have enrolled in the Latinos Combating Diabetes (La Comunidad) study. Of these, 191 are female, presenting the study team with a unique opportunity to examine the challenges faced by Latina women as they strive to make healthier lifestyle choices. Many of these women work more than one job or work longer hours, making it difficult to find time for exercise each day. Similarly, childcare, transportation, and rotating work schedules make attendance at the weekly group meetings problematic. The lack of affordable, healthy food choices that are both appealing and culturally appropriate can also make improving their diets difficult. Finally, some Latina women face challenges in fostering and maintaining support for weight-loss and healthy habits in their own households. The La Comunidad study could provide important insight into overcoming these barriers and improving health outcomes in Latina women.
Contributed by Mara Vitolins, lead researcher for The Latinos Combatiendo La Diabetes (La Comunidad) study. Dr. Vitolins is Professor, Epidemiology & Prevention Office of Women in Medicine and Science Center on Diabetes, Obesity, and Metabolism at Wake Forest School of Medicine, North Carolina (USA).
USA: DiabetesSisters offers support to all women with diabetes
Founded in 2008, DiabetesSisters is a non-profit organization dedicated to improving the health and quality of life of women with or at risk of developing diabetes. The organization serves the community both online and in-person, providing support and education in a safe, non-judgment zone.
Addressing the needs of women living with diabetes candidly, DiabetesSisters has tackled sensitive subjects such as pregnancy, parenting with diabetes, menopause and eating disorders, discussing and learning about each topic and providing professional and peer support along the way. Filling this gap has been instrumental in our success, with women returning to our events and discussing their progress. Another issue that has been prevalent has been stigma and isolation in living with diabetes. Our programming emphasizes that no woman should walk the path of diabetes alone. Because our community is inclusive, women with all kinds of diabetes can share their successes, triumphs, struggles and fears, and have other Sisters provide their own experiences in the same realm. We have recently started to speak about issues on the rising cost of medications and the fear in losing access to diabetes treatment.
The organization works with national government agencies, national corporations, private practitioners, women’s organizations, and diabetes organizations to carry the message of education, support, and empowerment to women with diabetes around the country. As of June 2017, the organization had over 13,000 registered members and nearly 10,000 social media followers. The website also receives half a million visitors annually.
Online, DiabetesSisters offers innovative, user-friendly web-based programs to address the various ways women prefer to connect with others and receive diabetes education. For women who prefer to learn through quiet observation, DiabetesSisters provides articles (blogs) from actual women living with type 1 and type 2 diabetes. In between visits with her healthcare team, a member can engage with healthcare professionals via our From the Experts Columns or download educational materials from our educational library. Registered members receive our monthly e-newsletter which features tips and resources for living better with diabetes. Additionally, DiabetesSisters offers a free Life Class Webinar Series, with a 30-minute focus on a specific diabetes-related topic.
Additionally, since 2009, DiabetesSisters has offered in-person monthly PODS (Part of DiabetesSisters) Meetups in various locations throughout the US, as well as a Virtual Meetup for those who cannot meet in person. Various times a year, we host a Global PODS Meetup, which has included women from Brazil, United Kingdom, India, and Ghana. In 2015, the organization received funding to offer a Leadership Institute open to PODS Leaders, where we come together to enhance skills in recruitment and facilitation, as well as receive more education in diabetes. We also offer a Weekend for Women Conference, which has become a signature event for DiabetesSisters, drawing attendees from all over the US with all types of diabetes of varying ages. Recently, DiabetesSisters launched a Minority Initiative Program, designed to reach underserved populations and provide more resources and everyday ways to improve life with diabetes. This program has offered programs such as cooking demonstrations, exercise suggestions, and resource sharing.
For more information on DiabetesSisters, please visit www.diabetessisters.org
Contributed by Anna Norton, CEO of DiabetesSisters.
Saudi Arabia: New opportunity for women and girls to access exercise
In Saudi Arabia, women cannot exercise with men and there are no public sports facilities for women, but things are changing. For the first time, women in Saudi Arabia are being encouraged to exercise in public gyms due to the efforts of a prominent Saudi princess, Princess Reema Bint Badar, who became head of a new Department of Women’s Affairs at the General Authority of Sports last year. This has been widely seen as signalling the potential for greater female access to sports in the Saudi Arabia, a country where women’s participation in sports has been relatively rare.
Following the appointment of Princess Reema in November 2016, the General Authority for Sports and the prestigious Princess Nora University in Riyadh, the largest women’s university, signed a memorandum of cooperation for the promotion of sports facilities with a view to the promotion of healthy lifestyles. Further plans in relation to women’s sports include:
• the licensing for the first time of women’s gyms; and
• modifying outdoor areas to allow women to work out without being seen by men.
Allowing gyms for women — and access to a healthier lifestyle — could make a huge difference for the overall health of Saudi women. Around 44 percent of women are classified as obese in Saudi Arabia, and the country has some of the world’s highest rates of obesity and diabetes.
When unveiling the licensing in March of 2017, Princess Reema said the change is about "opening the doors for our girls to live a healthy lifestyle." The Princess also said the Islamic Kingdom planned for every district and neighborhood to have a gym, and while swimming, running and bodybuilding will be allowed, a blanket ban will remain for competitive sports like tennis, football, volleyball and basketball.
Saudi Arabia is currently following a modernisation program called Saudi Vision 2030 where one of the aims is to increase the scale of community participation in sports from 13 per cent to 40 per cent by 2030.
From: Developments in Saudi Sports following Saudi Vision 2030: accessed on the Internet Sept 6, 2017; http://www.tamimi.com/en/magazine/law-update/section-14/dec-jan-2017/developments-in-saudi-sports-following-saudi-vision-2030.html