Gender Differences in Treatment Burden and Care Sustainability Among Adults Living With Diabetes

Abstract

ObjectiveWomen carry disproportionate shares of caregiving and other life demands that may compound the work of diabetes self-management. We sought to examine gender differences in overall and digital treatment burden and their key contributors.

Research Design and MethodsCross-sectional analysis of two cohorts of adults with type 1 or type 2 diabetes attending outpatient endocrinology visits who completed the Treatment Burden Questionnaire Plus Digital (TBQ+D) (n=472). Multivariable regression estimated gender differences in overall and digital treatment burden, ability to live a normal life, and sustainability of current self- care effort, adjusting for age, diabetes type, insulin intensity, HbA1c, and cohort. Item-level analyses identified contributors to observed differences.

ResultsCompared to men, women reported higher median overall treatment burden (33 vs 20, adjusted mean difference 10.6 points, 95% CI 5.1-16.3; p<.0001) and digital treatment burden (13 vs 7, adjusted mean difference 3.5 points, 95% CI 1.1-6.1; p=.009). They also had higher odds of not living a normal life (OR 1.77, 95% CI 1.18-2.67; p=0.006) and difficulty sustaining current self-care efforts indefinitely (OR 2.01, 95% CI 1.10-3.66; p=0.023). Digital burden differences were concentrated in annoyance, precautions, and time and effort required to use digital medicine tools, whereas contributors to differences in overall burden varied, with relationships, self-monitoring, and injections contributing most.

ConclusionsAfter adjusting for treatment intensity and other factors, women living with diabetes were twice as likely to be overwhelmed by diabetes care than men. Their greater vulnerability to treatment burden demands healthcare service redesign and individualization of plans of care that minimally disrupt patients and caregivers lives.

ARTICLE HIGHLIGHTSO_LIWhy did we undertake this study? C_LI

Women may experience greater treatment burden across chronic conditions, reflecting competing (caregiving) demands that reduce capacity for self-management. Gender differences in diabetes, especially digital burden, remain unclear. O_LIWhat is the specific question we wanted to answer? C_LI Do women with diabetes experience greater overall and digital treatment burden than men? O_LIWhat did we find? C_LI Women reported greater overall and digital burden and more difficulty living a normal life and sustaining care than men. Differences were larger for digital annoyance, precautions, and effort, plus relationships, self-monitoring, and injections. O_LIWhat are the implications? C_LI Treatment burden cannot be inferred from treatment intensity alone. Diabetes care should consider whether treatment work fits within each patients life and can be sustained. Women with diabetes may be particularly vulnerable to becoming overwhelmed by the work of diabetes care.

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BibTeX RIS

BibTeX

@misc{zahidy2026gender,
  title = {{Gender Differences in Treatment Burden and Care Sustainability Among Adults Living With Diabetes}},
  author = {M. Al Zahidy and F. D. Rivadeneira and O. M. Rabeaa and B. N. Shah and M. E. Branda and J. P. Brito and V. M. Montori},
  howpublished = {medRxiv},
  year = {2026},
  month = sep,
  doi = {10.64898/2026.09.08.26362531},
  url = {https://www.medrxiv.org/content/10.64898/2026.09.08.26362531v1},
  note = {CC BY-ND},
}

RIS

TY  - UNPB
TI  - Gender Differences in Treatment Burden and Care Sustainability Among Adults Living With Diabetes
AU  - M. Al Zahidy
AU  - F. D. Rivadeneira
AU  - O. M. Rabeaa
AU  - B. N. Shah
AU  - M. E. Branda
AU  - J. P. Brito
AU  - V. M. Montori
PY  - 2026
DA  - 2026/09/08
PB  - medRxiv
DO  - 10.64898/2026.09.08.26362531
UR  - https://www.medrxiv.org/content/10.64898/2026.09.08.26362531v1
AB  - ObjectiveWomen carry disproportionate shares of caregiving and other life demands that may compound the work of diabetes self-management. We sought to examine gender differences in overall and digital treatment burden and their key contributors.  Research Design and MethodsCross-sectional analysis of two cohorts of adults with type 1 or type 2 diabetes attending outpatient endocrinology visits who completed the Treatment Burden Questionnaire Plus Digital (TBQ+D) (n=472). Multivariable regression estimated gender differences in overall and digital treatment burden, ability to live a normal life, and sustainability of current self- care effort, adjusting for age, diabetes type, insulin intensity, HbA1c, and cohort. Item-level analyses identified contributors to observed differences.  ResultsCompared to men, women reported higher median overall treatment burden (33 vs 20, adjusted mean difference 10.6 points, 95% CI 5.1-16.3; p<.0001) and digital treatment burden (13 vs 7, adjusted mean difference 3.5 points, 95% CI 1.1-6.1; p=.009). They also had higher odds of not living a normal life (OR 1.77, 95% CI 1.18-2.67; p=0.006) and difficulty sustaining current self-care efforts indefinitely (OR 2.01, 95% CI 1.10-3.66; p=0.023). Digital burden differences were concentrated in annoyance, precautions, and time and effort required to use digital medicine tools, whereas contributors to differences in overall burden varied, with relationships, self-monitoring, and injections contributing most.  ConclusionsAfter adjusting for treatment intensity and other factors, women living with diabetes were twice as likely to be overwhelmed by diabetes care than men. Their greater vulnerability to treatment burden demands healthcare service redesign and individualization of plans of care that minimally disrupt patients and caregivers lives.  ARTICLE HIGHLIGHTSO_LIWhy did we undertake this study? C_LI  Women may experience greater treatment burden across chronic conditions, reflecting competing (caregiving) demands that reduce capacity for self-management. Gender differences in diabetes, especially digital burden, remain unclear. O_LIWhat is the specific question we wanted to answer? C_LI Do women with diabetes experience greater overall and digital treatment burden than men? O_LIWhat did we find? C_LI Women reported greater overall and digital burden and more difficulty living a normal life and sustaining care than men. Differences were larger for digital annoyance, precautions, and effort, plus relationships, self-monitoring, and injections. O_LIWhat are the implications? C_LI Treatment burden cannot be inferred from treatment intensity alone. Diabetes care should consider whether treatment work fits within each patients life and can be sustained. Women with diabetes may be particularly vulnerable to becoming overwhelmed by the work of diabetes care.
ER  -

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