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Diabetes: Few discussions, many cases, among men
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June is Men’s Health Month, an annual commemoration intended “to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys,” according to MensHealthMonth.org.
In recognition of this event, throughout the month, Healio Family Medicine will highlight a specific health condition and its impact on men. We began our series with a look at identifying and treating heart disease, the leading cause of death in men, according to the CDC. Last week, we examined a condition frequently overlooked in men — postpartum depression.
This week, our focus turns to diabetes, a condition that recent CDC data suggest is common, affecting about 1 in 10 males. In addition, a 2016 study in The Journal of Clinical Endocrinology & Metabolism reported that although the reasons are unclear, being male is emerging as a risk factor for type 2 diabetes.
Another study, this one in the European Journal of Internal Medicine, that followed up with randomly selected 14,223 patients in northern Europe that did not have self-reported type 2 diabetes or a nonfasting glucose of greater than 11.1 mmol per liter found that significantly more men than women developed type 2 diabetes mellitus.
Despite the increased prevalence, diabetes is not frequently discussed among men and their doctors, according to the American Diabetes Association.
“Historically, men have not been comfortable discussing issues about their health, particularly conditions like diabetes, depression or sexual dysfunction,” the association states on its website. “This has resulted in shorter and less healthy lives for men in the United States compared to women.”
To help bring diabetes more to the forefront of primary care physician and patient discussions, Healio Family Medicine asked Bradley S. Jones, MD, an internist with Baylor Scott & White Quality Alliance and Douglas K. Owens, MD, MS, general internist at Veterans Affairs Palo Alto Health Care System, and vice chair, U.S. Preventive Services Task Force, as well as Saleh Aldasouqi MD, chief of endocrinology, Michigan State University, for ways that PCPs can identify and treat diabetes in men, discuss the subject with their male patients and more. – by Janel Miller
Healio: How and why should a PCP broach the subject of diabetes with their male patients?
Owens: Clinicians can let their male patients know that by assessing programs that encourage improved lifestyle habits and behaviors, men can lower their risk of type 2 diabetes, along with other conditions such as heart disease and stroke.
Aldasouqi: As alluded above in the statement posted on the American Diabetes Association’s website, men are less willing to volunteer info about many health issues. I have observed this trend in my practice over the years. Until the American Diabetes Association and other health organizations consider launching educational campaigns to draw the attention of PCPs to engage patients in discussing the issue of diabetes more forcefully, similar to the campaigns on erectile dysfunction, PCPs are encouraged to incite info from their patients in the quest for the detection of undiagnosed diabetes. Because diabetes symptoms (such as polyuria and visual changes), can go unnoticed for a long time, many cases of diabetes can be missed.
Healio: What are some of the ways a man can prevent getting prediabetes or diabetes?
Jones: First and foremost, avoid sugar. This includes soft drinks, sports drinks and juices and even sugar in your coffee and tea. People should also avoid, as much as possible, processed and refined carbohydrates, such as white bread — even wheat bread that’s not whole grain — and white potatoes, white rice, white pasta.
Healio: A 2015 study in BMC Family Practice suggested that low HDL-cholesterol levels, obesity, and hypertension are modifiable risk factors independently related to the presence of prediabetes that were identified in the study. These same researchers wrote that “the magnitudes of the associations” were stronger for men vs. women. What are some of the risk factors for diabetes unique to men?
Jones: One of the biggest factors that put men at risk for full-blown diabetes is a family history of the disease. Other risk factors include poor diet, lack of exercise, and obesity, especially around the abdomen. As a primary care physician, we need to alert men to the importance of losing weight and avoiding a BMI more than 29, and 19 to 25 is ideal. The patient’s age and if he has had prior high blood pressure, or if he smokes doesn’t increase the risk for diabetes but does increase the risk for death, heart attack and stroke, especially if combined with type 2 diabetes.
Owens: The current USPSTF recommendations state that adults aged 40 to 70 years that are overweight or obese be screened for diabetes. This could lead to a PCP finding someone who needs treatment or finding someone who has an elevated glucose but has not yet reached the level of having diabetes. Lifestyle interventions that change a person’s modifiable risk factors can help reduce this latter group’s chance of developing full-blown diabetes. In addition, the USPSTF also recommends that men who are members of certain racial/ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may be at increased risk for diabetes at a younger age or at a lower BMI. Clinicians should consider screening persons with one or more of these characteristics who are overweight or obese.
Healio: Are there any misconceptions that PCPs may have about diabetes as it pertains to men?
Aldasouqi: Perhaps one misconception that could be pertinent to men is related to the symptom of polyuria, especially in middle aged and/or elderly men. There is the possibility that polyuria could be due to prostate problems, rather than diabetes, A primary care physician should be more cautious when taking a medical history from male patients, as polyuria is important both for screening for diabetes, as well as in patients with diabetes as a means of adequate control of glucose.
Healio: How can a PCP decide the right treatment for a patient?
Jones: If a patient has type 1 diabetes, he must use insulin. Those patients who have type 2 diabetes can keep their condition under control with healthy eating and exercise, but others will need medications, insulin, or a combination of both to meet their target blood glucose level.
Owens: Treatment decisions should be based in part on high his glucose is. Regimens should also be tailored based on lifestyles and interventions as needed to control their diabetes. Factors such as other medications the patient is on, these drugs’ adverse events must also be considered.
Healio: What is a patient’s medical outlook if he follows his prescription regimen and participates in lifestyle interventions?
Jones: Clinicians need to stress to patients that medications can work. There are interventions that can work now, but the patient needs to be seen and followed up with, and it’s not just once a year, it should be three or four times a year. Get the patient to see how these medications, and testing for these things, can have longer, more fruitful lives. Taking medications not only increases life expectancy but also overall quality of life. In addition, it reduces the risk for blindness, kidney failure, heart attack, stroke and amputations.
Disclosures: Aldasouqi reports receiving speaker honoraria from Alere (Abbott) and Janssen. Healio Family Medicine was unable to determine Jones’ relevant financial disclosures prior to publication. Owens reports no relevant financial disclosures.
References:
Almdal T, et al. Eur J Intern Med. 2008;doi:10.1016/j.ejm.2007.05.011.
CDC.gov. National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed June 6, 2018.
Diaz-Redondo, et al. BMC Fam Pract. 2015;doi:10.1186/s12875-014-0216.3
Diabetes.org. Medication. http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/. Accessed June 6, 2018.
Men’sHealthMonth.org. Men’s Health Month celebrated each June. http://www.menshealthmonth.org/. Accessed May 29, 2018.
Nordström A, et al. J Clin Endocrinol Metab. 2016;doi.org/10.1210/jc.2016-1915.
USPreventiveServicesTaskForce.org. Final Recommendation Statement: Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes#Pod5. Accessed June 5, 2018.