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Identifying and Reducing Gender Gaps in Diabetes Care and Research
Stefan Amisten, Senior Medical Writer, Touch Medical Media, UK
Matthew Goodwin,Group Director and Advisory Editor, Touch Medical Media, UK

-Insights into gender gaps in diabetes care and research, presented at the American Diabetes Association, Orlando, Florida, USA, 22–26 June 2018.

Exactly one hundred years ago, the British parliament passed an act granting the vote to women. Arguably, one century later, the struggle for gender equality is still ongoing.

Strictly from a biologist’s point of view, there are obvious physiological differences between men and women. Although the terms ‘sex’ and ‘gender’ are often used interchangeably, to a biologist, they have different meanings. Sex differences are due to biology-linked differences defined by genetics and reproductive hormones, Due to the physiology of human reproduction, hormonal changes are more pronounced over time in women than in men.1

Gender differences, on the other hand, are defined as behavioural differences between men and women, and are influenced by the local environment, nutrition, lifestyle and stress management. Interestingly, gender differences also affect our approaches towards medical treatments and disease prevention.1

Sex and gender are not strictly binary but exist in a continuum that influences how chronic diseases, such as diabetes,manifest and are treated in men and women.1 Several studies have demonstrated that women are less likely than men to receive more advanced diagnostic and therapeutic interventions. Interestingly, it is not clear if these differences are due togender differences (how male and female patients communicate disease symptoms and treatment expectations to healthcare professionals), or if they are due to biological differences defined by genetic sex.1-6

Type 2 diabetes (T2D) is a growing global healthcare challengethat is caused by a complex interplay between genetic and environmental risk factors. A growing body of evidence suggests that sex and gender differences affect the epidemiology, pathophysiology, treatment, and outcomes of non-communicable diseases such as T2D.1,7,8 For instance, women appear to receive inferior diabetes care and less favourable health outcomes compared with men,9 even though diabetic women are more than twice as likely as men to suffer life-threatening T2D complications, such as heart attacks.10

Gender differences seem to not only negatively affect female patientswith T2D, they also negatively impact women who work in diabetes research and diabetes clinical care. The U.S. Bureau of Labor Statistics reports that 47% of the U.S. workforce is female, but only 38% of medical doctors are women. In contrast, 90% of registered nurses are female, and women’s salaries are on average 82% that of men’s.11

Furthermore, women areunder-represented in the (Science, Technology, Engineering, Mathematics, and Medicine - STEMM) workforce, and are also underrepresented as authors of publications in prestigious journals. Without further reforms in academic publishing, education and mentoring, the STEMM gender gap will persist for generations.12-14

At the American Diabetes Association's (ADA’s) 78th Scientific Sessions on 22–26 June 2018 at Orlando’s Orange County Convention Center, a distinctive panel of female leaders in the field of diabetes care and research convened to discuss professional and healthcare gender inequalities relevant to diabetes care, research and healthcare careers.

Professor Elizabeth R. Seaquist, MD, Pennock Family Chair in Diabetes Research, Vice Chair for Clinical Affairs, and Director of the Division of Endocrinology and Diabetes at the University of Minnesota, outlined the gender gaps that exist in the clinical sciences, with a focus on rewards and career advancement for women.

Prof. Seaquist explained how gender gaps can be overcome with intervention programmes, presented findings and recommendations from a National Academies of Sciences and Medicine report on sexual harassment in academia,15 and shared her own personal encounters with gender discrimination as a female clinical investigator. She concluded that ‘the gender gap in medicine is real, and with an ongoing commitment throughout the healthcare infrastructure, we can affect change’. However, Prof. Seaquist is positive about the future, stating that increased diversity and a growing number of women in leadership roles in the academic medical setting provides the opportunity for critical perspectives and knowledge, which can improve diabetes care and clinical outcomes.

Gender issues impacting women in the diabetes field, particularly in nursing, health education, and psychology, were addressed by the ADA’s 2018 President of Health Care & Education, Dr Felicia Hill-Briggs, PhD, ABPP, Professor of medicine, physical medicine and rehabilitation, and acute and chronic care at the Johns Hopkins University. Dr. Hill-Briggs explained that due to societal gender bias,these disciplines often face undervaluing of their science, inequities in their professional standing, and fewer opportunities for advancement within academic medicine, which has contributed to lower priority and professional status for these expert disciplines and professionals. She then continued by sharing her personal experiences, barriers, and, ultimately, strategies for success as a female African-American academic diabetes researcher.

As a final agenda item, the Women’s Interprofessional Network of the American Diabetes Association (WIN ADA) co-chair Jane E.B. Reusch, MD, Professor of medicine, biochemistry and bioengineering, and associate director of the Center for Women’s Health Research at the University of Colorado School of Medicine Anschutz Medical Campus, and ADA’s 2018 President of Medicine & Science, highlighted the WIN ADA programme. Prof. Reusch stressed that women are an integral part of the national workforce, and that she is proud that there has been an increase in the number of women entering STEMM careers. Although there are still barriers to be addressed, she explained, discussions such as these ADA sessions create pathways and facilitate enhanced opportunities for female clinicians and researchers that will ultimatelyresult in optimal care for people with diabetes.

In conclusion, after more than a century of gender equality reforms, gender inequality still exists and can negatively influences women in academic and medical professions as well as the patients that they care for.

There is a clear need for inspirational female role models in diabetes care and research, and the speakers at the ADA Gender Gaps in Science sessions embody such positive role models. We believe that the WIN ADA movement is a model for the future, and part of the solution to the gender gap problem, and we look forward to following how a new generation of successful and inspirational female healthcare professionals rise to the challenge of transforming diabetes research and clinical care, one female healthcare professional and patient at a time.

References

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15. Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. Available at: http://sites.nationalacademies.org/shstudy/index.htm(accessed 13 July 2018).