According to the International Diabetes Federation, in 2021, 10.5% of adults aged 20 to 79 worldwide, or 537 million people, were diagnosed with diabetes. This represents a significant increase from 463 million people diagnosed in 2019. If current trends continue, it is projected that by 2030, 11.3% of adults, or 643 million people, will have diabetes, and by 2045, 12.2% of adults, or 783 million people, will be diagnosed with the condition. Diabetes is also a major cause of premature death and various complications, contributing to a substantial number of fatalities [1].

Based on the information provided, as of 2021, the prevalence of diabetes among individuals aged 19 and older was 12.8% for men and 7.8% for women, with a tendency for increased prevalence among men. Both men and women exhibited higher prevalence rates with increasing age [2]. A structured online survey conducted in October 2023, which included 1,000 adults aged 20 years and older from across the country, with proportional representation based on gender, age, and region, revealed that 91.4% of participants view diabetes as a serious health concern. Among individuals without a prior diagnosis of diabetes, 68.3% expressed apprehension about the possibility of developing diabetes or elevated blood sugar levels. [2]. The survey results indicated that the level of awareness regarding 'prediabetes' and 'glycated hemoglobin' remained relatively low, with only 61.3% and 38.1% of respondents, respectively, being familiar with these terms. Furthermore, approximately one-third of the participants reported that they actively manage their weight and waist circumference while adhering to regular dietary and exercise routines [2]. Despite a high level of awareness regarding insulin injections and their perceived necessity, only approximately 50% of respondents indicated a willingness to undergo insulin therapy. This underscores the importance of disseminating information about the advantages of insulin therapy and its potential to improve overall quality of life [3]. Diabetic patients need to continuously manage their health by following dietary guidelines, engaging in regular exercise, and adhering to medication regimens in order to control their blood sugar levels effectively [4].

Type 1 diabetes can prevent complications through proper meal management, exercise, and appropriate medication therapy [5]. However, due to significant blood glucose fluctuations, there is a higher risk of hypoglycemia in Type 1 diabetes. The use of continuous glucose monitors and insulin pumps can help patients prevent hypoglycemia and maintain target blood glucose levels. Therefore, guidelines recommend the use of these devices for individuals with Type 1 diabetes [6].

However, there are metabolic differences between genders, with healthy women showing 41% greater insulin sensitivity compared to men. This gender difference also affects the response to treatment for Type 2 diabetes. In women starting insulin therapy, hypoglycemia is more common when using basal insulin compared to men, and improvements in glycated hemoglobin (HbA1c) are less significant [7]. Additionally, among employees, diabetes management differs by gender. For men, better blood glucose control was associated with insulin therapy, absence of hyperlipidemia, having breakfast at least three times a week, and dining out 3 to 4 times a week, with higher odds ratios compared to other groups. For women, those who were unmarried and did not consume alcohol had a higher likelihood of better blood glucose control compared to other groups.

Given the increasing prevalence of diabetes and the issues with ineffective diabetes management, it is essential to analyze gender-specific approaches to diabetes management to enhance its effectiveness. This analysis aims to identify tailored strategies for managing diabetes based on gender differences, ultimately improving overall diabetes care.

Study Design

This study is a descriptive correlational research that utilizes raw data from the Community Health Survey to analyze the differences in diabetes management methods based on gender among adults in their 30s with diabetes.

Participants

Using the sampling framework of the Community Health Survey, a total of 30,699 individuals diagnosed with diabetes, aged 30 and older, residing in South Korea, were selected as participants. Among them, 15,446 were men and 15,253 were women.

Data Collection

The Community Health Survey data serves as the basis for the annual reports published by the Korea Disease Control and Prevention Agency. According to Article 4 of the Local Health Act, the survey is the only standardized assessment conducted annually by the national government and local governments to evaluate and promote the health levels of residents in specific areas. It plays a central role in the production system of regional health statistics. The Community Health Survey is a statutory survey conducted based on Article 4 of the Local Health Act to assess the health status of local residents and identify the causes of health issues. It is an approved statistical survey (approval number 117075). The survey began in 2008 and annually examines approximately 230,000 adults aged 19 and older, selected as samples from various regions.

The data for this study were collected from the Community Health Survey conducted from 2021 to 2023 [9-11]. This secondary data includes information gathered over three years through household member verification, health surveys, health check-ups, and nutrition surveys. Specifically, data from the health survey and health check-up components were utilized. The Community Health Survey complies with the Personal Information Protection Act and the Statistical Act, ensuring that only anonymized data that does not allow for the identification of households or individuals are made publicly available. Data that could not identify individuals were downloaded from the Community Health Survey website for this study.

Ethical Considerations

The data used in this study, derived from the Community Health Survey, falls under research conducted by the government for public welfare, as specified in Article 2(1) of the Bioethics Act and Article 2(2)(1) of its enforcement regulations. Therefore, this research does not require approval from an ethics review board. The researcher downloaded and analyzed the publicly available raw data from the Community Health Survey website, ensuring compliance with the guidelines for data usage.

Measurement Instruments

Demographic Characteristics

In this study, demographic characteristics were measured based on the survey data from the Community Health Survey. The following six variables were used as demographic control variables: age groups (30s, 40s, 50s, 60s, 70 and above), smoking status, alcohol consumption status, marital status, education level (elementary school graduate or below, middle school graduate, high school graduate, college graduate or higher), and economic activity status.

Diabetes participants

In this study, "gender in diabetes" refers to the distinction between male and female individuals diagnosed with diabetes who are 30 years of age or older.

Subjective Health Status

In this study, subjective health status was reclassified using a scoring system (very poor＝1 point, poor＝2 points, fair＝3 points, good＝4 points, very good＝5 points). A higher score indicates a better subjective health status.

key factors for self-management of diabetes

Non-Pharmacological Therap (Yes or No), Pharmacotherapy (Yes or No), Insulin Management (Yes or No), Management Education (Yes or No), Diabetic Retinopathy Screening (Yes or No), Diabetic Nephropathy Screening (Yes or No), Frequency of Hemoglobin A1c Testing (Yes or No), Vigorous physical activity time (Yes or No), Moderate physical activity time (Yes or No), Walking time (Yes or No).

Statistical analysis

The data analysis in this study involved analyzing general characteristics using percentages. Differences in gender based on these characteristics were assessed using chi-square analysis. The diabetes self-management methods based on gender were analyzed using both chi-square analysis and independent t-tests.

General characterization

The general characteristics of the study are as follows (Table 1). The study included 15,446 men and 15,253 women. Age distribution showed that the fewest participants were in their 30s or younger (603 individuals, 2.0%), while the largest group was those aged 70 and older (13,719 individuals, 44.7%). Regarding smoking status, 25,645 participants (83.5%) did not smoke, whereas 22,861 participants (74.5%) consumed alcohol. In terms of subjective health status, the most common response was ‘average,’ reported by 12,742 individuals (41.5%).

Differences in Gender Based on General Characteristics

The analysis of general characteristics by gender is as follows (Table 2). Significant differences by gender were found in age, smoking status, alcohol consumption, marital status, education level, economic activity, and subjective health status (p<0.001).

Analysis of Differences in Diabetes Self-Management According to Gender

The analysis of differences in diabetes self-management by gender is as follows (Table 3). Significant differences were found in non-pharmacological therapy (p<0.001), pharmacotherapy (p<0.046), insulin management (p<0.002), management education (p<0.001), and diabetic nephropathy screening (p<0.001). The frequency of hemoglobin A1c testing was higher in men (2.54 times, SD＝1.32) compared to women (2.43 times, SD＝1.34) (p<0.001). Additionally, women engaged in more vigorous physical activity time (p<0.001), moderate physical activity time (p<0.001), and walking time (p<0.001) compared to men.

This study aimed to analyze the self-management of diabetes patients diagnosed after their 30s based on gender and to propose effective management methods. Based on the key findings, the following discussion will be presented. This study addresses the lack of prior research on diabetes management based on gender by discussing findings across the entire participant population.

Here’s a brief overview of the components related to diabetes management, particularly focusing on gender differences and important aspects.

This study revealed differences in management education. In individuals who received diabetes education, there was a significant improvement in blood sugar control, including fasting blood glucose, postprandial blood glucose, and HbA1c levels. In contrast, those who did not receive education experienced a continuous deterioration in HbA1c and an increase in the incidence of complications. This highlights the crucial role of diabetes education in managing blood sugar levels and preventing complications. This suggests a connection to the present study [12]. In the early stages of diabetes, it is recommended to provide medical management and diabetes self-management education in a hospital setting, followed by ongoing self-management education in accessible community settings [13]. Management Education, tailored education programs that address specific concerns and barriers faced by men and women can improve self-management skills.

The findings of this study support that non-pharmacological interventions, particularly when used alongside insulin therapy in obese patients, can effectively manage type 1 diabetes [14]. Non-Pharmacological Therapy, lifestyle changes, including diet and exercise, play a crucial role in diabetes management. Men and women may respond differently to these lifestyle modifications. Behavioral interventions tailored to gender differences in motivation and barriers can enhance the sustainability of healthy habits.

The findings of this study support that pharmacological approaches, including insulin, metformin, sodium-glucose co-transporter 2 (SGLT2) inhibitors, sulfonylureas, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase IV (DPP-4) inhibitors, represent some of the most important strategies in diabetes management [15]. Pharmacotherapy, medication choices can vary, as men and women may respond differently to certain diabetes medications due to physiological differences. Tailored approaches can enhance effectiveness. Factors influencing medication adherence can also differ between genders, impacting overall management.

The significant differences in recommended strategies for insulin management to promote weight loss through regular exercise, as well as adjustments to prevent hypoglycemia and hyperglycemia, align with the findings of this study [16]. Insulin Management, insulin therapy, including dosing and management, can vary based on individual needs. There may be gender-based differences in insulin sensitivity and metabolism. In the area of exercise, studies show that women tend to engage more diligently in physical activity for diabetes management compared to men. Research indicates that women often participate more actively in exercise programs and have a stronger motivation to maintain healthy lifestyles. These differences may be related to variations in health management approaches and levels of social support. Recognizing this trend, it is important to design and support exercise programs that effectively cater to women's needs.

There were also gender differences observed in diabetic retinopathy screening and diabetic nephropathy screening, which aligns with findings that investigated the association between diabetic retinopathy (DR) and chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) [17-19]. Therefore, regular screening is essential to prevent diabetic retinopathy and kidney disease.

Recognizing and addressing these gender differences can enhance personalized treatment and improve outcomes in diabetes management.

This study aimed to analyze the self-management of diabetes patients diagnosed after their 30s based on gender and to propose effective management methods.

Based on the results, the following conclusions and recommendations are made. Both men and women need to incorporate 2-3 strategies in their diabetes management. In effective exercise therapy for diabetes management, it was found that women tend to exercise more diligently than men, highlighting the need to create better conditions for men to engage in physical activity. Future research is anticipated to verify the effects of various combined diabetes management methods.