Our study provides information about diabetes-related QoL and its assessment by women and men with T2DM in Poland, Slovakia, and the Czech Republic based on a study that employs the widely used DM-specific ADDQoL scale.[16, 19–21]
The issue of the QoL is also addressed by the International Diabetes Federation which considers the quality of life as one of the fundamental goals of diabetes care, along with metabolic control and prevention. This is because it has been proven that laboratory results which are so important for physicians, are important for patients with DM only to the extent that they affect their physical, emotional and social well-being, namely the quality of life.[22]
Currently, there are few studies presenting sex differences with regard to the quality of life of DM patients, and studies that assess the quality of life of women and men with the use of the ADDQoL tool are very rare.
In our study, we focussed on identifying features that differentiated female groups from male ones in individual countries, and on examining the quality of life of DM patients with regard to sex in individual countries.
The subjective assessement of patients' quality of life is affected by clinical, as well as social and demographic factors.[22]
In the analyzed group of women, the overall average quality of life was slightly higher in Czech women than in women from Slovakia and Poland.
In general, women form all three countries assessed their quality of life as good and very good. Men also rated their overall quality of life as good and very good. In the group of men, the average quality of life was slightly higher in Slovaks than in Poles and Czechs. In our study, it can however be noted that the generally perceived quality of life in the study group is higher in men than in women.
Similar results were obtained in a study by Kurowska et al. Although the study used a different research tool for assessing the level of QoL, men from the study group obtained definitely higher scores than women in the domain of psychology,[23] which can also be interpreted in line with other studies that conclude that men have higher self-confidence in terms of their ability of self-care and management of diabetes, and they less frequently are anxious due to their illness or experience depressive disorders. Hence the good knowledge and a positive attitude that are the predictors of adherence to self-care rules and are conducive to good QoL.[24–26]
In studies by Pufal et al.,[27] and in a work by Lewko and Krajewska-Kułak,[28] as well as by Glasgow,[29] sex also differentiated participants in terms of satisfaction with the quality of life. The authors claim that women had lower scores because of their lower self-reported quality of life compared to men. They referred the results to a higher propensity of women to depressive states.
Also, the results of studies by Polish authors indicate that the quality of life is significantly reduced by the female gender and the symptoms of depression[30] and anxiety.
Quite the opposite results, pointing to a lower quality of life in a group of men, were obtained by D´Souza et al.[31] who concluded that women, in general, better cope with compliance with therapy rules, and therefore have better results for HbA1c levels and a lower BMI and hence their quality of life, in general, is higher. These findings are consistent with other studies which have proven that the duration of diabetes, fasting blood glucose[32] and a positive attitude to treatment[33–34] are conducive to a better perception of the quality of life by women.
Szcześniak and Żmurowska[35] concluded in their study that gender does not constitute a factor differentiating the participants in terms of the assessment of the quality of life.
In our study, it can be noted that the quality of life received the highest scores from Polish patients, both women, and men. There are also no significant differences neither between women from Poland, the Czech Republic, and Slovakia, nor between men from Poland, the Czech Republic, and Slovakia.
About 50% of female (most of them from Poland) and male (most of them from the Czech Republic) participants with type 2 diabetes declared at least a good level of QoL. On the other hand, more than 80% of participants (both women and men) in each country stated that their quality of life would be better without DM.
Similar results were obtained by Golińska et al. in a study in which the majority of participants of both genders assessed their quality of life as good, but no statistically significant correlation was found between gender and QoL.[36]
Similar results were obtained also in a study by Chudiak et al. in which participants unanimously stated that their quality of life would be much better had it not been for their diabetes.[37]
In the study group, the weighted impact scores were negative for all the domains. The lowest scores in all three groups of women and in all three groups of men were obtained for "freedom to eat".
Studies by the present authors demonstrate that for both women and men, diabetes has the greatest impact on "freedom to eat" and "freedom to drink", which confirms that dietary restrictions related to the non-pharmacological control of diabetes are burdensome to them. The need for adherence to a dietary regime affects the presence of early complications of diabetes, such as hypoglycemia and hyperglycemia, the levels of HbA1C, as well as the occurrence of a variety of complications and overweight present in a large group of women and men in the study group.
Studies by the present authors confirm previous studies carried out in Poland,[16, 38] as well as in other countries, such as Argentina,[39] Greece, or cross-sectional studies with the participation of patients from nine European[21] countries.
In a study by Bradley conducted with the use of ADDQoL among patients with type 1 and type 2 diabetes mellitus, the negative impact of diabetes on the quality of life in all domains was confirmed for almost all cases, despite a high level of satisfaction with treatment observed in the patients. Adherence to the diet had a dominant impact on the quality of life, and it was perceived by the participants as very restrictive.[14]
The least affected domains of life in all of the groups of women and men were "living conditions", then "people’s reaction" for Polish and Czech men and women, and Slovak men, and "leisure activities" for Slovak women.
Almost in the middle of the scale, there is the impact of diabetes on "sex life". Diabetes has a higher impact on this aspect of life in men (in all groups), and a slightly lower impact in women (the highest in Slovak women, then in Polish and Czech women). Sexual dysfunctions in women with diabetes are primarily impaired libido and pain during intercourse, mainly due to vaginal dryness.[40–42] Sexual problems in men with diabetes involve erectile dysfunction, with the problem increasing with the duration of diabetes.[43–44] This common, increasing, and embarrassing problem poses a challenge for contemporary diabetes care, as confirmed by the authors' own study, although our analyses pointed to a higher intensity of this problem in men. The results of a study by Bąk et al.[45] also confirm that diabetes has a negative impact on the quality of life of patients with diabetes in Poland, especially in terms of "freedom to eat", "freedom to drink" and "sex life" in both genders of patients with T1DM, "freedom to eat," "freedom to drink" and "feelings about the future" in both genders, and "working life" and "sex life" in men with T2DM.
The average weighted impact (AWI) score in the authors' own study was the lowest for Slovak women, then for Polish and Czech women. This was slightly different in the male group. The lowest weighted impact scores were obtained for Czech men, then for Slovak and Polish men. It can be noted that the average weighted impact (AWI) was higher for men. In general, it can be concluded that diabetes has a small negative impact on all the study groups, regardless of gender. Authors from Poland [35, 38] and from other countries obtained similar results.[21]
Glasgow et al. in a study involving DM patients conducted with the use of the SF-20 questionnaire, demonstrated that a lower quality of life was influenced by such factors as a low level of education, older age, female gender, type of social insurance, number of complications of diabetes, number of comorbidities and low level of physical activity during the activities of daily living.[30]
Also, functional capacity is a significant factor determining the quality of life of patients with diabetes mellitus. What is more, the quality of life is significantly reduced by the female gender, autonomic or peripheral neuropathy, lack of physical activity, high BMI, and symptoms of depression and anxiety.[31]
The authors' own study did not reveal any statistically significant impact of the selected social and demographic factors on the extent to which diabetes affects women and men. However, it was noted that in the study group both women and men were characterized by a small negative impact of diabetes on the overall quality of life.