Abstract
Objective
To analyze the pattern of diabetes symptoms and to estimate the association between diabetes symptom severity (level of discomfort perceived by a patient due to diabetes symptoms) among different socio-demographic variables for both women and men.
Methods
Primary cross-sectional data of 583 diagnosed patients (51.3% and 48.7%, women and men, respectively) were collected from Punjab, India. Frequency percentage distribution and negative binomial regressions (NBR) were used for analysis.
Results
More men were asymptomatic compared to women. Both genders perceived increased hunger, thirst, and frequent urination in their early stages of diabetes. More women than men have experienced hormonal change as their first symptom with a higher severity level. NBR analyzed the association between discomfort perceived by both genders due to symptoms among different socio-demographic categories. Urban patients (incidence rate ratio—IRR: 0.90) were significantly (p = 0.056) less likely to perceive discomfort than their rural counterparts, whereas men (IRR: 0.93) reported more significant discomfort than women (IRR: 0.88) in the urban area. Literate patients [Up to class 10 (IRR: 0.87), (p = 0.013) and 11–above (IRR: 0.85), (p = 0.022) categories] were significantly less likely to perceive discomfort. In all education categories, women professed more significant discomfort than men.
Conclusion
Given the differences in symptoms between the two genders, this paper will help comprehend the disease development process and limit the possibilities of misdiagnosis. This study will assist in identifying the order of the symptoms among both genders.
Keywords: Gender, Diabetes, Symptoms, Severity, India
Introduction
Health is vital for a better quality of life and a prerequisite for development. However, diabetes substantially burdens well-being and is a critical public health concern worldwide [1]. In this line, the International Diabetes Federation (IDF) estimates that if no effective preventative strategies are implemented, the burden of diabetes will rise steeply to 643 million by 2030 and 783 million by 2045 [2].
This increasing burden of diabetes is positively associated with sex and gender differences in society, which arise mainly due to differences in biological and social characteristics [3]. Likewise, the sex differentials can be seen in diabetes symptoms too. For instance, erectile dysfunction and penile curvature are male-specific symptoms, whereas yeast infections and painful sex are female-specific symptoms [4]. Similarly, society’s array of socially constructed roles and responsibilities to the two sexes causes gender differences in the symptoms of diseases, such as coronary artery disease, stroke, cancer, etc. [5, 6]. Thus, these gender differences in the symptoms may also occur in the case of diabetes [7].
Just like gender, a symptom is a subjective indication of a change in a disease or condition as perceived only by the patient [8], generally described as any experience of illness or physical or mental change brought on by disease [9]. Here, subjectivity refers to the fact that patients may only feel symptoms like anxiety, low back pain, loss of appetite, etc. [10]. Therefore, to understand the evolution of chronic diseases such as diabetes and to lessen the chances of misdiagnosis, the physicians essentially understand which symptom appeared first, followed by others [11]. Studying symptoms may help in early disease detection but has been given little priority in research [12, 13].
Though some research has been conducted on the relevance of symptoms, there is a solid need to study the same through a gender lens [14, 15]. Since the gender component has been found to be an essential dimension in reducing the burden of diabetes [16], in this line, our study has attempted to understand the pattern of diabetes symptoms among women and men separately. Although a significant amount of research on gender and diabetes exists in the literature, gender differences study in the case of diabetes symptoms seems to be lacking in the literature [17, 18]. Consequently, the present study analyzed the pattern and severity of perceived diabetes symptoms among women and men patients in Punjab, India. We chose Punjab because it is one of the fastest growing and wealthiest states in India, facing an advanced epidemiological transition phase and a significant gender gap in the case of diabetes.
Methodology
Objective
The primary objective of this study was to analyze the pattern of diabetes symptoms among women and men separately. The additional aim of the research was to estimate the association between diabetes symptom severity (level of discomfort perceived by a patient due to diabetes symptoms) among different socio-demographic variables for both genders in the study area, which will help reduce the overall diabetes burden.
Data and sampling methods
The present paper is based on primary cross-sectional data of diabetic patients collected through well-structured questionnaires from different districts of Punjab, India. All the data on diabetes-related symptoms were collected during the course of diabetes of the patients, where the average duration of diagnosis was 4.75 years. A sample of households was selected with the help of a multi-stage purposive random sampling method [19]. We followed the WHO steps methodology to prepare, design, and select the samples in the study area and used the census of 2011 as the sampling frame [20, 21]. The standard methods procedures have been described in detail previously [22].
Statistical analysis
We have performed descriptive statistics, such as frequency and percentage distribution, along with negative binomial regressions (NBR) using the STATA 17 version to calculate the results.
Description of models
In our NBR, the dependent variable was a count variable that shows a patient’s symptom severity score. Our questionnaire contained a list of ten diabetes symptoms (increased hunger, increased thirst, weight loss, frequent urination, blurry vision, extreme fatigue, poor muscle strength, dry and itchy skin, hormonal changes, and any others) taken from the medical literature. We have used a five-point Likert scale to calculate the diabetes symptom severity score. This was based on a continuum from high-H (a severe, continuous, life-disturbing problem), moderate-M (a moderate or considerable problem often present and/or at a moderate level), low-L (a slight or mild problem generally mild or intermittent), no problem-N; where H = 4, M = 3, L = 2, N = 1 and no symptom-A = 0 (asymptomatic). Therefore, the maximum score for any patient could be 40, and the minimum score is zero. High scores indicated a higher level of discomfort patients face due to diabetes symptoms and vice versa. The independent variables were categorical, including different socio-demographic variables (see Table 1).
Table 1.
Gender-wise sample distribution of diabetes patients among different socio-demographic groups
| Characteristics | Women cases (%) | Men cases (%) | Total cases (%) |
|---|---|---|---|
| Punjab | 299 (51.3) | 284 (48.7) | 583 (100) |
| Resident type | |||
| Rural | 179 (59.9) | 145 (51.1) | 324 (55.6) |
| Urban | 120 (40.1) | 139 (48.9) | 259 (44.4) |
| Age group | |||
| 19–50 | 89 (29.8) | 80 (28.2) | 169 (29.0) |
| 51–60 | 95 (31.8) | 77 (27.2) | 172 (29.6) |
| 61–above | 115 (38.5) | 127 (44.8) | 242 (41.6) |
| Religion | |||
| Others (Hindu, Muslim) | 103 (34.4) | 107 (37.7) | 210 (36.0) |
| Sikh | 196 (65.6) | 177 (62.3) | 373 (64.0) |
| Social category | |||
| Others | 182 (60.9) | 186 (65.5) | 368 (63.1) |
| SC and OBC | 117 (39.1) | 98 (34.5) | 215 (36.9) |
| Wealth quartile | |||
| 1st | 87 (29.1) | 61 (21.5) | 148 (25.4) |
| 2nd | 73 (24.5) | 71 (25.0) | 144 (24.7) |
| 3rd | 84 (28.1) | 76 (26.8) | 160 (27.5) |
| 4th | 55 (18.4) | 76 (26.8) | 131 (22.5) |
| Educational level | |||
| Illiterate | 127 (42.5) | 55 (19.4) | 182 (31.3) |
| Up to class 10 | 126 (42.2) | 134 (47.2) | 260 (44.6) |
| 11–above | 46 (15.4) | 95 (33.5) | 141 (24.2) |
| Type of work | |||
| Domestic work | 216 (72.3) | 26 (9.2) | 242 (41.6) |
| Self-employed | 33 (11.1) | 125 (44.1) | 158 (27.2) |
| Othersa | 50 (16.8) | 133 (46.9) | 183 (31.4) |
| Marital status | |||
| Married | 202 (67.6) | 248 (87.4) | 450 (77.2) |
| Othersb | 97 (32.5) | 36 (12.7) | 133 (22.9) |
| Household size (µ = 4.83 person) | |||
| Below average | 218 (72.9) | 197 (69.4) | 415 (71.2) |
| Above average | 81 (27.1) | 87 (30.6) | 168 (28.8) |
| Size of the land holding | |||
| Only residence | 203 (67.9) | 200 (70.4) | 403 (69.1) |
| Residence with agricultural land | 96 (32.1) | 84 (29.6) | 180 (30.9) |
| Primary source of cooking | |||
| LPG | 260 (87.0) | 257 (90.5) | 517 (88.7) |
| No LPG | 39 (13.0) | 27 (9.5) | 66 (11.3) |
| Water purifying system | |||
| Nonelectric | 168 (56.2) | 141 (49.6) | 309 (53.0) |
| Electric | 131 (43.8) | 143 (50.4) | 274 (47.0) |
| Type of latrine | |||
| Flush system | 133 (44.5) | 139 (48.9) | 272 (46.7) |
| No flush system | 166 (55.5) | 145 (51.1) | 311 (53.3) |
| Household material | |||
| Concrete | 268 (89.6) | 268 (94.4) | 536 (91.9) |
| Mixed | 31 (10.4) | 16 (5.6) | 47 (8.1) |
| Separate kitchen for cooking | |||
| No | 31 (10.4) | 24 (8.5) | 55 (9.4) |
| Yes | 268 (89.6) | 260 (91.5) | 528 (90.6) |
| Gender of house owner | |||
| Women | 75 (25.1) | 14 (4.9) | 89 (15.3) |
| Men | 224 (74.9) | 270 (95.1) | 494 (84.7) |
| Body mass index in (kilogram/mass2) | |||
| Underweight (< 18.5) | 12 (4.1) | 21 (7.4) | 33 (5.7) |
| Normal (18.5–24.9) | 136 (45.4) | 144 (50.7) | 280 (48.1) |
| Overweight (25.0–29.9) | 98 (32.7) | 95 (33.5) | 193 (33.1) |
| Obese (≥ 30) | 53 (17.8) | 24 (8.4) | 77 (13.1) |
| Sitting time per day in (hours) | |||
| Low (< 4) | 30 (10.1) | 57 (20.1) | 87 (15.0) |
| Medium (4–8) | 136 (45.4) | 104 (36.6) | 240 (41.2) |
| High (8–11) | 88 (29.4) | 78 (27.5) | 166 (28.4) |
| Very high (> 11) | 45 (15.1) | 45 (15.8) | 90 (15.4) |
| Physical inactivity | |||
| No | 162 (54.2) | 128 (45.0) | 290 (49.7) |
| Yes | 137 (45.8) | 156 (55.0) | 293 (50.3) |
| Irregular diet | |||
| No | 11 (3.7) | 12 (4.2) | 23 (3.9) |
| Yes | 288 (96.3) | 272 (95.8) | 560 (96.1) |
| Alcohol consumption | |||
| No | 299 (100) | 235 (82.7) | 534 (91.6) |
| Yes | 0 (0.0) | 49 (17.3) | 49 (8.4) |
| Tobacco consumption | |||
| No | 299 (100) | 269 (94.7) | 568 (97.4) |
| Yes | 0 (0.0) | 15 (5.3) | 15 (2.6) |
| Non-vegetarian food consumption | |||
| No | 217 (72.6) | 195 (68.7) | 413 (70.8) |
| Yes | 82 (27.4) | 89 (31.3) | 170 (29.2) |
| Per person per month cooking oil consumption (µ = 1.02 L) | |||
| Below average | 179 (59.9) | 181 (63.7) | 360 (61.7) |
| Above average | 120 (40.1) | 103 (36.3) | 223 (38.3) |
| Family history of diabetes | |||
| No | 238 (79.6) | 211 (74.3) | 449 (77.0) |
| Yes | 61 (20.4) | 73 (25.7) | 134 (23.0) |
aCasual wage labor, regular salaried, rentiers, pensioners, etc.
bUnmarried, widowed, divorced, separated., µ = average
Results
Table 1 shows the sample distribution of 538 diabetes patients across critical socio-demographic factors, with 299 (51.3%) women and 284 (48.7%) men aged 19–50, 51–60, and 61–above. In our study, 324 (55.6%) patients were included from rural areas and 259 (44.4%) from urban areas. Our results showed that the proportion of diabetic patients has increased as we moved from lower to higher age groups. In addition, women (42.5%) have a more significant proportion of illiterates than men (19.4%). Furthermore, just 15.4% of women have attended class 11–above education, compared to 33.5% of men. Besides, most patients were from the Sikh community (64.0%), of which 65.6% were women and 62.3% were men, respectively. Whereas, the others (which includes the general category) in the social classes make up 63.1% of patients, consisting of 60.9% women and 65.5% men. Domestic workers accounted for around 77.3% of women and 9.2% of men; self-employment accounts for 11.1% of women and 44.1% of men. Regarding marital status, 87.4% of men were married, compared to 67.6% of women patients. The average household size was 4.83 people (higher than India’s average of 4.44 people), with the majority of patients (consisting of more men (72.9%) than women (69.4%)) belonging to below-average household size families. Likewise, the average per person per month cooking oil consumption was 1.02 L (less than India’s average of 1.42 L), where 61.7% of patients consumed less oil. Additionally, the proportion of patients with only residences without agricultural land (69.1%) was higher. In the case of risk factors, women were at higher risk in body mass index (54.6%), sitting time per day (89.9%), and physical inactivity (54.2%). In comparison, men were at higher risk in cases of non-vegetarian food consumption (31.3%), family history of diabetes (25.7%), alcohol (17.3%), and tobacco consumption (5.3%) and having irregular diet (4.2%). Overall, we have noted that most patients were at high risk of BMI (51.9%), and their daily sitting time (85.0%) was high. Furthermore, diabetes patients in the study area consumed minimal or no sugar.
A gender-wise pattern of diabetes symptoms among diabetes patients
Table 2 shows the pattern of diabetes symptoms among women and men. During the survey, we interviewed patients about the order in which their diabetes symptoms appeared. Because diabetes is a chronic disease, patients take time to manifest and report their symptoms. Thus, it is critical to study the order of the diabetes symptoms in which they appear. At the time of the interview, the patients differentiated their five diabetes symptoms in the order in which they occurred. Symptom patterns in the table show that 4.3% of men were asymptomatic in the first order compared to 3.7% of women. As the order progressed, women reported proportionally more symptoms than men. We observed a slight gender difference in symptoms in first-order cases, except that more men were likely to perceive extreme fatigue. In contrast, more women had dry and itchy skin and hormonal changes.
Table 2.
Gender-wise pattern of diabetes symptoms among diabetes patients
| Symptoms (↓) | Women | Men | Total | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Order of the occurrence (→) | 1st | 2nd | 3rd | 4th | 5th | 1st | 2nd | 3rd | 4th | 5th | 1st | 2nd | 3rd | 4th | 5th |
| Asymptomatic | 11 (3.7) | 49 (16.4) | 106 (35.5) | 179 (59.9) | 232 (77.6) | 12 (4.3) | 48 (17.0) | 125 (44.1) | 200 (70.5) | 243 (85.6) | 23 (4.0) | 97 (16.7) | 231 (39.7) | 379 (65.1) | 475 (81.5) |
| Increased hunger | 87 (29.1) | 37 (12.4) | 9 (3.1) | 8 (2.7) | 1 (0.4) | 81 (28.6) | 23 (8.1) | 12 (4.3) | 3 (1.1) | 1 (0.4) | 168 (28.9) | 60 (10.3) | 21 (3.7) | 11 (1.9) | 2 (0.4) |
| Increased thirst | 35 (11.8) | 55 (18.4) | 24 (8.1) | 9 (3.1) | 5 (1.7) | 36 (12.7) | 59 (20.8) | 20 (7.1) | 10 (3.6) | 3 (1.1) | 71 (12.2) | 114 (19.6) | 44 (7.6) | 19 (3.3) | 8 (1.4) |
| Weight loss | 26 (8.7) | 32 (10.8) | 18 (6.1) | 11 (3.7) | 5 (1.7) | 25 (8.9) | 22 (7.8) | 24 (8.5) | 8 (2.9) | 7 (2.5) | 51 (8.8) | 54 (9.3) | 42 (7.3) | 19 (3.3) | 12 (2.1) |
| Frequent urination | 34 (11.4) | 29 (9.7) | 38 (12.8) | 11 (3.7) | 6 (2.1) | 31 (11.0) | 32 (11.3) | 28 (9.9) | 11 (3.9) | 7 (2.5) | 65 (11.2) | 61 (10.5) | 66 (11.4) | 22 (3.8) | 13 (2.3) |
| Blurry vision | 15 (5.1) | 17 (5.7) | 15 (5.1) | 16 (5.4) | 11 (3.7) | 14 (5.0) | 20 (7.1) | 17 (6.0) | 15 (5.3) | 5 (1.8) | 29 (5.0) | 37 (6.4) | 32 (5.5) | 31 (5.4) | 16 (2.8) |
| Extreme fatigue | 16 (5.4) | 22 (7.4) | 25 (8.4) | 16 (5.4) | 7 (2.4) | 21 (7.4) | 18 (6.4) | 12 (4.3) | 10 (3.6) | 3 (1.1) | 37 (6.4) | 40 (6.9) | 37 (6.4) | 26 (4.5) | 10 (1.8) |
| Poor muscle strength | 27 (9.1) | 28 (9.4) | 22 (7.4) | 26 (8.7) | 7 (2.4) | 23 (8.1) | 20 (7.1) | 21 (7.4) | 8 (2.9) | 7 (2.5) | 50 (8.6) | 48 (8.3) | 43 (7.4) | 34 (5.9) | 14 (2.5) |
| Dry, itchy skin | 11 (3.7) | 6 (2.1) | 12 (4.1) | 10 (3.4) | 7 (2.4) | 4 (1.5) | 17 (6.0) | 10 (3.6) | 11 (3.9) | 5 (1.8) | 15 (2.6) | 23 (4.0) | 22 (3.8) | 21 (3.7) | 12 (2.1) |
| Hormonal changes | 14 (4.7) | 3 (1.1) | 7 (2.4) | 4 (1.4) | 3 (1.1) | 2 (0.8) | 3 (1.1) | 1 (0.4) | 1 (0.4) | 0 (0.0) | 16 (2.8) | 6 (1.1) | 8 (1.4) | 5 (0.9) | 3 (0.6) |
| Others | 23 (7.7) | 21 (7.0) | 23 (7.7) | 9 (3.0) | 15 (5.0) | 35 (12.3) | 22 (7.7) | 14 (4.9) | 7 (2.5) | 3 (1.1) | 58 (9.9) | 43 (7.4) | 37 (6.3) | 16 (2.7) | 18 (3.1) |
However, there was a substantial gender difference in perceived symptoms noted from the second-order cases. Women were more likely to perceive increased hunger, weight loss, extreme fatigue, and poor muscle strength. In contrast, men were more likely to perceive symptoms, such as increased thirst, frequent urination, blurry vision, and dry and itchy skin. We found that the gender difference in diabetes symptoms persists with the order of occurrence progressing from third to fourth and so on. In cases of the third order, for instance, more women perceived all symptoms except increased hunger, weight loss and blurry vision. In total, symptoms like increased hunger (28.9%), increased thirst (12.2%) and frequent urination (11.2%) were perceived by both women and men in their early stages of diabetes.
Gender-wise analysis of the severity of diabetes symptoms among diabetes patients
In line with the pattern of symptoms, Table 3 extended the analysis in case of severity of diabetes symptoms in each order of occurrence among both genders. The severity level of the first order, irrespective of its type, is higher among men (42.3%) than women (41.5%). Additionally, a higher proportion of patients were in the high and medium severity category (41.9% and 41.2%, respectively). In the case of both genders, for many patients, increased hunger was the first symptom with high severity, followed by frequent urination and increased thirst. In the first order of occurrence of the symptoms, gender analysis revealed that 10.1% of women perceived high severity of increased hunger compared to 9.6% of men.
Table 3.
Gender-wise sample distribution of the severity of diabetes symptoms among diabetes patients
| Symptoms (↓) Order of the occurrence ( →) |
1st | 2nd | 3rd | 4th | 5th | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Severity ( →) | H | M | L | N | H | M | L | N | H | M | L | N | H | M | L | N | H | M | L | N |
| Women | ||||||||||||||||||||
| Increased hunger | 30 (10.1) | 43 (14.4) | 13 (4.4) | 1 (0.4) | 6 (2.1) | 20 (6.7) | 11 (3.7) | 0 (0.0) | 2 (0.7) | 3 (1.1) | 4 (1.4) | 0 (0.0) | 1 (0.4) | 4 (1.4) | 3 (1.1) | 0 (0.0) | 0 (0.0) | 1 (0.4) | 0 (0.0) | 0 (0.0) |
| Increased thirst | 16 (5.4) | 18 (6.1) | 1 (0.4) | 0 (0.0) | 21 (7.1) | 31 (10.4) | 3 (1.1) | 0 (0.0) | 6 (2.1) | 14 (4.7) | 4 (1.4) | 0 (0.0) | 0 (0.0) | 8 (2.7) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 3 (1.1) | 1 (0.4) | 1 (0.4) |
| Weight loss | 1 (0.4) | 15 (5.1) | 10 (3.4) | 0 (0.0) | 3 (1.1) | 16 (5.4) | 13 (4.4) | 0 (0.0) | 1 (0.4) | 9 (3.1) | 6 (2.1) | 2 (0.7) | 1 (0.4) | 8 (2.7) | 2 (0.7) | 0 (0.0) | 0 (0.0) | 3 (1.1) | 2 (0.7) | 0 (0.0) |
| Frequent urination | 23 (7.7) | 11 (3.7) | 0 (0.0) | 0 (0.0) | 24 (8.1) | 5 (1.7) | 0 (0.0) | 0 (0.0) | 23 (7.7) | 15 (5.1) | 0 (0.0) | 0 (0.0) | 7 (2.4) | 3 (1.1) | 1 (0.4) | 0 (0.0) | 4 (1.4) | 2 (0.7) | 0 (0.0) | 0 (0.0) |
| Blurry vision | 4 (1.4) | 6 (2.1) | 5 (1.7) | 0 (0.0) | 5 (1.7) | 7 (2.4) | 5 (1.7) | 0 (0.0) | 2 (0.7) | 10 (3.4) | 3 (1.1) | 0 (0.0) | 4 (1.4) | 7 (2.4) | 4 (1.4) | 1 (0.4) | 2 (0.7) | 7 (2.4) | 2 (0.7) | 0 (0.0) |
| Extreme fatigue | 10 (3.4) | 6 (2.1) | 0 (0.0) | 0 (0.0) | 6 (2.1) | 14 (4.7) | 2 (0.7) | 0 (0.0) | 6 (2.1) | 18 (6.1) | 1 (0.4) | 0 (0.0) | 6 (2.1) | 10 (3.4) | 0 (0.0) | 0 (0.0) | 4 (1.4) | 2 (0.7) | 1 (0.4) | 0 (0.0) |
| Poor muscle strength | 10 (3.4) | 14 (4.7) | 3 (1.1) | 0 (0.0) | 7 (2.4) | 15 (5.1) | 6 (2.1) | 0 (0.0) | 5 (1.7) | 13 (4.4) | 4 (1.4) | 0 (0.0) | 1 (0.4) | 16 (5.4) | 7 (2.4) | 2 (0.7) | 2 (0.7) | 2 (0.7) | 3 (1.1) | 0 (0.0) |
| Dry, itchy skin | 6 (2.1) | 4 (1.4) | 0 (0.0) | 1 (0.4) | 1 (0.4) | 4 (1.4) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 7 (2.4) | 2 (0.7) | 3 (1.1) | 1 (0.4) | 5 (1.7) | 4 (1.4) | 0 (0.0) | 1 (0.4) | 3 (1.1) | 3 (1.1) | 0 (0.0) |
| Hormonal changes | 11 (3.7) | 1 (0.4) | 2 (0.7) | 0 (0.0) | 1 (0.4) | 2 (0.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 7 (2.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3 (1.1) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 3 (1.1) | 0 (0.0) | 0 (0.0) |
| Others | 13 (4.4) | 4 (1.4) | 1 (0.4) | 5 (1.7) | 9 (3.1) | 12 (4.1) | 0 (0.0) | 0 (0.0) | 5 (1.7) | 16 (5.4) | 2 (0.7) | 0 (0.0) | 3 (1.1) | 3 (1.1) | 3 (1.1) | 0 (0.0) | 3 (1.1) | 6 (2.1) | 6 (2.1) | 0 (0.0) |
| Total | 124 (41.5) | 122 (40.9) | 35 (11.8) | 7 (2.4) | 83 (27.8) | 126 (42.2) | 41 (13.8) | 0 (0.0) | 50 (16.8) | 112 (37.5) | 26 (8.7) | 5 (1.7) | 24 (8.1) | 67 (22.5) | 26 (8.7) | 3 (1.1) | 16 (5.4) | 32 (10.8) | 18 (6.1) | 1 (0.4) |
| Men | ||||||||||||||||||||
| Increased hunger | 27 (9.6) | 45 (15.9) | 7 (2.5) | 2 (0.8) | 8 (2.9) | 10 (3.6) | 5 (1.8) | 0 (0.0) | 3 (1.1) | 6 (2.2) | 3 (1.1) | 0 (0.0) | 1 (0.4) | 2 (0.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (0.4) | 0 (0.0) | 0 (0.0) |
| Increased thirst | 18 (6.4) | 12 (4.3) | 6 (2.2) | 0 (0.0) | 18 (6.4) | 39 (13.8) | 2 (0.8) | 0 (0.0) | 8 (2.9) | 10 (3.6) | 2 (0.8) | 0 (0.0) | 0 (0.0) | 7 (2.5) | 3 (1.1) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 1 (0.4) | 0 (0.0) |
| Weight loss | 6 (2.2) | 14 (5.0) | 5 (1.8) | 0 (0.0) | 1 (0.4) | 15 (5.3) | 6 (2.2) | 0 (0.0) | 4 (1.5) | 15 (5.3) | 5 (1.8) | 0 (0.0) | 3 (1.1) | 5 (1.8) | 0 (0.0) | 0 (0.0) | 1 (0.4) | 3 (1.1) | 3 (1.1) | 0 (0.0) |
| Frequent urination | 23 (8.1) | 6 (2.2) | 1 (0.4) | 1 (0.4) | 23 (8.1) | 9 (3.2) | 0 (0.0) | 0 (0.0) | 18 (6.4) | 8 (2.9) | 2 (0.8) | 0 (0.0) | 5 (1.8) | 4 (1.5) | 2 (0.8) | 0 (0.0) | 3 (1.1) | 3 (1.1) | 1 (0.4) | 0 (0.0) |
| Blurry vision | 6 (2.2) | 8 (2.9) | 0 (0.0) | 0 (0.0) | 5 (1.8) | 7 (2.5) | 8 (2.9) | 0 (0.0) | 1 (0.4) | 9 (3.2) | 7 (2.5) | 0 (0.0) | 5 (1.8) | 5 (1.8) | 5 (1.8) | 0 (0.0) | 3 (1.1) | 2 (0.8) | 0 (0.0) | 0 (0.0) |
| Extreme fatigue | 10 (3.6) | 8 (2.9) | 3 (1.1) | 0 (0.0) | 7 (2.5) | 9 (3.2) | 2 (0.8) | 0 (0.0) | 1 (0.4) | 8 (2.9) | 3 (1.1) | 0 (0.0) | 0 (0.0) | 10 (3.6) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 0 (0.0) | 1 (0.4) | 0 (0.0) |
| Poor muscle strength | 8 (2.9) | 11 (3.9) | 4 (1.5) | 0 (0.0) | 5 (1.8) | 13 (4.6) | 2 (0.8) | 0 (0.0) | 3 (1.1) | 12 (4.3) | 6 (2.2) | 0 (0.0) | 0 (0.0) | 4 (1.5) | 4 (1.5) | 0 (0.0) | 0 (0.0) | 6 (2.2) | 1 (0.4) | 0 (0.0) |
| Dry, itchy skin | 2 (0.8) | 2 (0.8) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 13 (4.6) | 2 (0.8) | 0 (0.0) | 2 (0.8) | 7 (2.5) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 6 (2.2) | 5 (1.8) | 0 (0.0) | 1 (0.4) | 2 (0.8) | 2 (0.8) | 0 (0.0) |
| Hormonal changes | 2 (0.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (0.4) | 0 (0.0) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Others | 18 (6.4) | 12 (4.3) | 2 (0.8) | 3 (1.1) | 6 (2.2) | 14 (5.0) | 1 (0.4) | 1 (0.4) | 7 (2.5) | 7 (2.5) | 0 (0.0) | 0 (0.0) | 1 (0.4) | 4 (1.5) | 2 (0.8) | 0 (0.0) | 1 (0.4) | 1 (0.4) | 1 (0.4) | 0 (0.0) |
| Total | 120 (42.3) | 118 (41.6) | 28 (9.9) | 6 (2.2) | 75 (26.5) | 131 (46.2) | 29 (10.3) | 1 (0.4) | 47 (16.6) | 82 (28.9) | 30 (10.6) | 0 (0.0) | 16 (5.7) | 47 (16.6) | 21 (7.4) | 0 (0.0) | 11 (3.9) | 20 (7.1) | 10 (3.6) | 0 (0.0) |
| Total | ||||||||||||||||||||
| Increased hunger | 57 (9.8) | 88 (15.1) | 20 (3.5) | 3 (0.6) | 14 (2.5) | 30 (5.2) | 16 (2.8) | 0 (0.0) | 5 (0.9) | 9 (1.6) | 7 (1.3) | 0 (0.0) | 2 (0.4) | 6 (1.1) | 3 (0.6) | 0 (0.0) | 0 (0.0) | 2 (0.4) | 0 (0.0) | 0 (0.0) |
| Increased thirst | 34 (5.9) | 30 (5.2) | 7 (1.3) | 0 (0.0) | 39 (6.7) | 70 (12.1) | 5 (0.9) | 0 (0.0) | 14 (2.5) | 24 (4.2) | 6 (1.1) | 0 (0.0) | 0 (0.0) | 15 (2.6) | 4 (0.7) | 0 (0.0) | 0 (0.0) | 5 (0.9) | 2 (0.4) | 1 (0.2) |
| Weight loss | 7 (1.3) | 29 (5.0) | 15 (2.6) | 0 (0.0) | 4 (0.7) | 31 (5.4) | 19 (3.3) | 0 (0.0) | 5 (0.9) | 24 (4.2) | 11 (1.9) | 0 (0.0) | 4 (0.7) | 13 (2.3) | 2 (0.4) | 0 (0.0) | 1 (0.2) | 6 (1.1) | 5 (0.9) | 0 (0.0) |
| Frequent urination | 46 (7.9) | 17 (3.0) | 1 (0.2) | 1 (0.2) | 47 (8.1) | 14 (2.5) | 0 (0.0) | 0 (0.0) | 41 (7.1) | 23 (4.0) | 2 (0.4) | 0 (0.0) | 12 (2.1) | 7 (1.3) | 3 (0.6) | 0 (0.0) | 7 (1.3) | 5 (0.9) | 1 (0.2) | 0 (0.0) |
| Blurry vision | 10 (1.8) | 14 (2.5) | 5 (0.9) | 0 (0.0) | 10 (1.8) | 14 (2.5) | 13 (2.3) | 0 (0.0) | 3 (0.6) | 19 (3.3) | 10 (1.8) | 0 (0.0) | 9 (1.6) | 12 (2.1) | 9 (1.6) | 1 (0.2) | 5 (0.9) | 9 (1.6) | 2 (0.4) | 0 (0.0) |
| Extreme fatigue | 20 (3.5) | 14 (2.5) | 3 (0.6) | 0 (0.0) | 13 (2.3) | 23 (4.0) | 4 (0.7) | 0 (0.0) | 7 (1.3) | 26 (4.5) | 4 (0.7) | 0 (0.0) | 6 (1.1) | 20 (3.5) | 0 (0.0) | 0 (0.0) | 6 (1.1) | 2 (0.4) | 2 (0.4) | 0 (0.0) |
| Poor muscle strength | 18 (3.1) | 25 (4.3) | 7 (1.3) | 0 (0.0) | 12 (2.1) | 28 (4.9) | 8 (1.4) | 0 (0.0) | 8 (1.4) | 25 (4.3) | 10 (1.8) | 0 (0.0) | 1 (0.2) | 20 (3.5) | 11 (1.9) | 2 (0.4) | 2 (0.4) | 8 (1.4) | 4 (0.7) | 0 (0.0) |
| Dry, itchy skin | 8 (1.4) | 6 (1.1) | 0 (0.0) | 1 (0.2) | 3 (0.6) | 17 (3.0) | 3 (0.6) | 0 (0.0) | 2 (0.4) | 14 (2.5) | 3 (0.6) | 3 (0.6) | 1 (0.2) | 11 (1.9) | 9 (1.6) | 0 (0.0) | 2 (0.4) | 5 (0.9) | 5 (0.9) | 0 (0.0) |
| Hormonal changes | 13 (2.3) | 1 (0.2) | 2 (0.4) | 0 (0.0) | 1 (0.2) | 4 (0.7) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 7 (1.3) | 1 (0.2) | 0 (0.0) | 1 (0.2) | 3 (0.6) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 3 (0.6) | 0 (0.0) | 0 (0.0) |
| Others | 31 (5.4) | 16 (2.8) | 3 (0.6) | 8 (1.4) | 15 (2.6) | 26 (4.5) | 1 (0.2) | 1 (0.2) | 12 (2.1) | 23 (4.0) | 2 (0.4) | 0 (0.0) | 4 (0.7) | 7 (1.3) | 5 (0.9) | 0 (0.0) | 4 (0.7) | 7 (1.3) | 7 (1.3) | 0 (0.0) |
| Total | 244 (41.9) | 240 (41.2) | 63 (10.9) | 13 (2.3) | 158 (27.2) | 257 (44.1) | 70 (12.1) | 1 (0.2) | 97 (16.7) | 194 (33.3) | 56 (9.7) | 5 (0.9) | 40 (6.9) | 114 (19.6) | 47 (8.1) | 3 (0.6) | 27 (4.7) | 52 (9.0) | 28 (4.9) | 1 (0.2) |
H—high (a severe, continuous, life-disturbing problem), M—moderate (a moderate or considerable problem often present and/or at a moderate level), L—low (a slight or mild problem generally mild or intermittent), N—no problem by symptom
In comparison, 15.9% of men perceived medium severity of increased hunger compared to 14.4% of women. A reverse pattern was noted in the case of increased thirst, where 6.4% of men perceived high severity compared to 5.4% of women, while 6.4% of women perceived medium severity of increased thirst compared to 4.3% of men. This pattern was the same in the case of weight loss and frequent urination. In the second order of symptoms, for 18.8% of patients (with a higher figure for men (20.2%) than women (17.5%)), increased thirst is the most prevalent symptom with high and medium severity followed by frequent urination (10.6%) in case of both the genders. The study has also found that many patients had experienced weight loss (5.4%), increased hunger (5.2%), poor muscle strength (4.9%), and extreme fatigue (4.0%) with medium severity as their second symptom. For different genders separately, these figures were higher for women than men. This study has found that more women (3.7%) compared to men (0.8%) had experienced hormonal change as their first symptom with a higher severity level.
Negative binomial regression: symptoms severity among different socio-demographic variables
Table 4 extends our analysis to the NBR, where we looked into the association between diabetes symptoms severity score (level of discomfort perceived by a patient due to diabetes symptoms) among different socio-demographic variables for both genders. The regression analysis showed that patients residing in urban areas (IRR: 0.88) were significantly (p = 0.022) less likely to perceive discomfort from diabetes symptoms than their rural counterparts (IRR: 1.00), in which urban women (IRR: 0.86) were perceiving lesser discomfort than urban men (IRR: 0.90), and still the result is significant (p = 0.056) only for women. With increasing age, discomfort from diabetes symptoms showed a disparate pattern among both genders. Furthermore, Sikh women (IRR: 0.94) perceived lesser discomfort in all the religion categories, but the results were insignificant. However, in the case of social categories, SC and OBC men (IRR: 0.90) reported lesser discomfort from diabetes symptoms. With increasing wealth, discomfort from diabetes symptoms showed an uneven pattern among women and men, except that men’s discomfort decreased with an increase in wealth than their counterparts. Overall, across the different education levels, literate patients (educated up to class 10 (IRR: 0.91) and 11–above (IRR: 0.85) categories) were significantly less likely to perceive discomfort from diabetes symptoms. However, in all literacy categories, women coped with more discomfort from the symptoms than men, but the results were significant for men only. Analysis of the different types of work showed that both genders in the other category (IRR: 0.91) were significantly (p = 0.086) perceiving less discomfort than their counterparts. Besides, others (IRR: 0.99), which include unmarried, widowed, divorced, and separated patients in the case of marital status, reported less discomfort than married patients. Those patients who belonged to above average household size (IRR: 0.93) were perceived less discomfort. In the case of type of latrine, patients who belonged to those houses with no flush system (IRR: 0.91) were significantly (p = 0.065) perceiving lesser discomfort. We found a significant difference in the discomfort level in the case of per person per month cooking oil consumption (p = 0.093) and separate kitchen for cooking (p = 0.071). Men patients significantly (p = 0.049) perceived higher discomfort (IRR: 1.34) where the gender of the house owner was men. Overweight women were mainly (p = 0.039) perceived higher discomfort (IRR: 1.16). With increasing daily sitting time, discomfort from diabetes symptoms showed a disparate pattern among both genders. Gender differential was found in the case of irregular diet, where men (IRR: 1.15) perceived higher discomfort than women (IRR: 0.88). Interestingly, physically active women (IRR: 0.76) and men (IRR: 0.78) significantly (p = 0.000) perceived lesser discomfort. Those men patients consuming tobacco (IRR: 1.22) perceived higher discomfort. In addition, patients (IRR: 1.13) with a family history of diabetes were significantly (p = 0.024) perceiving higher discomfort, whereas, the likelihood of discomfort is significantly (p = 0.014) higher among women (IRR: 1.20).
Table 4.
Negative binomial regression showing the association between diabetes symptoms severity score among different socio-demographic variables
| Severity score (Discomfort) | Women | Men | Total | |||
|---|---|---|---|---|---|---|
| IRR (σ) | P >|z| | IRR (σ) | P >|z| | IRR (σ) | P >|z| | |
| Resident type | ||||||
| Rural | 1.00 | 1.00 | 1.00 | |||
| Urban | 0.86 (0.07) | 0.056** | 0.90 (0.07) | 0.186 | 0.88 (0.05) | 0.022* |
| Age group | ||||||
| 19–50 | 1.00 | 1.00 | 1.00 | |||
| 51–60 | 0.97 (0.08) | 0.726 | 0.93 (0.08) | 0.386 | 0.95 (0.05) | 0.410 |
| 61–above | 1.00 (0.08) | 0.967 | 0.89 (0.07) | 0.172 | 0.95 (0.05) | 0.398 |
| Religion | ||||||
| Others (Hindu, Muslim) | 1.00 | 1.00 | 1.00 | |||
| Sikh | 0.94 (0.07) | 0.420 | 1.01 (0.07) | 0.858 | 0.98 (0.05) | 0.746 |
| Social category | ||||||
| Others | 1.00 | 1.00 | 1.00 | |||
| SC and OBC | 1.03 (0.08) | 0.701 | 0.90 (0.07) | 0.161 | 0.96 (0.05) | 0.399 |
| Wealth quartile | ||||||
| 1st | 1.00 | 1.00 | 1.00 | |||
| 2nd | 1.03 (0.08) | 0.679 | 0.99 (0.09) | 0.922 | 1.03 (0.06) | 0.682 |
| 3rd | 1.04 (0.09) | 0.597 | 0.97 (0.09) | 0.787 | 1.03 (0.06) | 0.620 |
| 4th | 0.96 (0.10) | 0.693 | 0.91 (0.10) | 0.400 | 0.95 (0.07) | 0.499 |
| Educational level | ||||||
| Illiterate | 1.00 | 1.00 | 1.00 | |||
| Up to class 10 | 1.03 (0.07) | 0.713 | 0.82 (0.07) | 0.024* | 0.91 (0.05) | 0.084** |
| 11–above | 1.00 (0.10) | 0.977 | 0.75 (0.08) | 0.006* | 0.85 (0.06) | 0.023* |
| Type of work | ||||||
| Domestic work | 1.00 | 1.00 | 1.00 | |||
| Self-employed | 1.16 (0.11) | 0.130 | 1.11 (0.13) | 0.363 | 1.02 (0.06) | 0.594 |
| Others (casual wage labor, regular salaried, rentiers, pensioners etc.) | 0.92 (0.08) | 0.327 | 1.00 (0.12) | 0.967 | 0.91 (0.05) | 0.086** |
| Marital status | ||||||
| Married | 1.00 | 1.00 | 1.00 | |||
| Others (unmarried, widowed, divorced, separated) | 0.98 (0.09) | 0.845 | 0.99 (0.10) | 0.927 | 0.99 (0.06) | 0.924 |
| Household size | ||||||
| Below average | 1.00 | 1.00 | 1.00 | |||
| Above average | 0.95 (0.06) | 0.384 | 0.95 (0.07) | 0.506 | 0.93 (0.04) | 0.163 |
| Size of the land holding | ||||||
| Only residence | 1.00 | 1.00 | 1.00 | |||
| Residence with agricultural land | 1.07 (0.08) | 0.404 | 0.99 (0.08) | 0.899 | 1.02 (0.05) | 0.691 |
| Primary source of cooking | ||||||
| LPG | 1.00 | 1.00 | 1.00 | |||
| No LPG | 0.93 (0.09) | 0.504 | 1.04 (0.13) | 0.729 | 0.99 (0.07) | 0.921 |
| Water purifying system | ||||||
| Nonelectric | 1.00 | 1.00 | 1.00 | |||
| Electric | 1.06 (0.07) | 0.352 | 1.09 (0.08) | 0.248 | 1.07 (0.05) | 0.155 |
| Type of latrine | ||||||
| Flush system | 1.00 | 1.00 | 1.00 | |||
| No flush system | 0.92 (0.06) | 0.233 | 0.95 (0.07) | 0.506 | 0.91 (0.04) | 0.065** |
| Household material | ||||||
| Concrete | 1.00 | 1.00 | 1.00 | |||
| Mixed | 0.87 (0.09) | 0.192 | 1.02 (0.14) | 0.876 | 0.96 (0.08) | 0.607 |
| Separate kitchen for cooking | ||||||
| No | 1.00 | 1.00 | 1.00 | |||
| Yes | 0.79 (0.9) | 0.030* | 0.86 (0.11) | 0.245 | 0.86 (0.07) | 0.071** |
| Gender of house owner | ||||||
| Women | 1.00 | 1.00 | 1.00 | |||
| Men | 1.04 (0.09) | 0.641 | 1.34 (0.21) | 0.049* | 1.10 (0.08) | 0.200 |
| Body mass index in (kilogram/mass2) | ||||||
| Normal (18.5–24.9) | 1.00 | 1.00 | 1.00 | |||
| Underweight (< 18.5) | 1.06 (0.16) | 0.685 | 0.94 (0.12) | 0.600 | 1.03 (0.10) | 0.787 |
| Overweight (25.0–29.9) | 1.16 (0.08) | 0.039* | 0.90 (0.06) | 0.146 | 1.00 (0.05) | 1.000 |
| Obese (≥ 30) | 1.14 (0.09) | 0.114 | 0.93 (0.11) | 0.555 | 1.04 (0.07) | 0.543 |
| Sitting time per day in (hours) | ||||||
| Low (< 4) | 1.00 | 1.00 | 1.00 | |||
| Medium (4–8) | 0.90 (0.09) | 0.294 | 0.93 (0.09) | 0.456 | 0.92 (0.06) | 0.233 |
| High (8–11) | 1.00 (0.11) | 0.978 | 0.88 (0.09) | 0.186 | 0.93 (0.07) | 0.313 |
| Very high (> 11) | 0.88 (0.11) | 0.326 | 0.94 (0.11) | 0.589 | 0.91 (0.08) | 0.258 |
| Physical inactivity | ||||||
| No | 1.00 | 1.00 | 1.00 | |||
| Yes | 0.76 (0.05) | 0.000* | 0.78 (0.05) | 0.000* | 0.79 (0.40) | 0.000* |
| Irregular diet | ||||||
| No | 1.00 | 1.00 | 1.00 | |||
| Yes | 0.88 (0.14) | 0.423 | 1.15 (0.19) | 0.395 | 1.00 (0.11) | 0.978 |
| Alcohol consumption | ||||||
| No | – | 1.00 | 1.00 | |||
| Yes | – | – | 0.99 (0.09) | 0.939 | 0.97 (0.08) | 0.978 |
| Tobacco consumption | ||||||
| No | – | 1.00 | 1.00 | |||
| Yes | – | – | 1.22 (0.17) | 0.152 | 1.13 (0.15) | 0.341 |
| Non-vegetarian food consumption | ||||||
| No | 1.00 | 1.00 | 1.00 | |||
| Yes | 1.06 (0.07) | 0.412 | 1.08 (0.08) | 0.314 | 1.07 (0.05) | 0.172 |
| Per person per month cooking oil consumption | ||||||
| Below average | 1.00 | 1.00 | 1.00 | |||
| Above average | 0.94 (0.06) | 0.335 | 0.91 (0.06) | 0.192 | 0.93 (0.04) | 0.093** |
| Family history of diabetes | ||||||
| No | 1.00 | 1.00 | 1.00 | |||
| Yes | 1.20 (0.09) | 0.014* | 1.05 (0.08) | 0.553 | 1.13 (0.06) | 0.024* |
Values in parenthesis are standard error (σ)
*Significant at 95% confidence interval
**Significant at 90% confidence interval
Discussion and policy implications
Gender mainstreaming is a practice to promote gender equality and has received wide recognition worldwide. The notion suggests that including a gender perspective in research, development, policy, and planning will help achieve equality [23]. Therefore, in context with the mainstreaming notion, this study presents a systematic analysis of the significance of gender research in the case of diabetes symptoms. Gender research in the case of diabetes symptoms is one of the least explored areas where most gender studies have focused on the differences in burden, prevalence, risk factors, type of diabetes, coping mechanisms, etc. [17, 24–26]. Therefore, incorporating a gender perspective into the study of diabetes symptoms may help design an appropriate diabetes prevention measure. A gender lens assists in the early diagnosis and detection of symptoms that could be key to diabetes prevention [27].
Nevertheless, the ideal preventive management plan for any disease, including diabetes, comprises four aspects: individual, societal, national, and global [28]. Out of this, better lifestyle management at the individual level is crucial and can be achieved through small and large-scale human cooperation [29]. At the individual level, prevention and management techniques solely involve modification of risk factors (such as alcohol, tobacco, irregular diet, physical inactivity, etc.) [30], leaving out self-detection of diabetes through awareness of symptoms and early reporting at primary health care. For instance, many individuals ignore the symptoms of diabetes because of its chronic course; they do not see it as a significant condition and are unaware that damage begins years before symptoms appear [31].
Since diabetes is asymptomatic in its early stages, we found that more men are asymptomatic than women in the study area. It is evident from the literature that asymptomatic diabetes is generally type 2 diabetes, which is more common among men than women [7]. Patients with type 2 diabetes sometimes show no symptoms at first; in reality, they may be asymptomatic for many years [32]. At the same time, these asymptomatic patients may have asymptomatic hyperglycemia (including impaired glucose tolerance), putting them at greater risk for the development of cardiovascular diseases (CVDs) [33]. This may be one of the reasons for the higher premature mortality among men due to CVDs than women [34]. Hence, to avoid such complications, one should be made aware of the warning signs of diabetes. In this analysis, men perceive extreme fatigue while women perceive dry and itchy skin and hormonal changes in the early stages of diabetes and should seek medical attention promptly. We have found a substantial gender differential in the second order of occurrence of symptoms in which more women than men perceive increased hunger, weight loss, extreme fatigue, and poor muscle strength. In contrast, men perceive increased thirst, frequent urination, blurry vision, and dry and itchy skin. Therefore, women and men who perceive the above symptom pattern should check their blood sugar levels regularly. Early detection and reporting of these symptoms to doctors can help treat the condition and prevent further vascular problems [35]. In addition, it may lessen the morbidity and mortality due to diabetes while reducing the financial burden of diabetes care in the country [34]. People with diabetes, or those at risk of developing it, require tailored, proactive, and long-term care [36]. Hence, necessary interventions through primary health care can be delivered to strengthen the early detection and timely treatment of the disease [37]. To accomplish this plan, people with diabetes should be aware of the early-stage symptoms (including increased hunger, increased thirst and frequent urination for both women and men respectively) and seek medical help without delay. Hence, raising awareness of detectable symptoms is recommended [38]. Simultaneously, it may reduce potential socio-economic and other health consequences [39].
For instance, it has been reported that men tend to communicate their symptoms straightforwardly, while women provide ambiguous symptom descriptions due to hesitation [40]. This could be one of the reasons that, in our analysis, the total perceived severity level for the first order of symptoms is higher among men than women. Sometimes, patients may notice a symptom, but it does not bother them [41]. This might be why our analysis found that for the same symptom, in the same order, the severity level varied between different genders. Gender-specific tracking and tracing of diabetes symptoms in hospitals should be maintained on a centralized system. As per our analysis of the first order of symptoms, more women reported higher severity of increased hunger than men, whereas more men perceived medium severity of increased hunger than women.
On the other hand, the pattern is reversed in the case of increased thirst, weight loss, and frequent urination. In such a case, the patient and their family are usually responsible for managing symptoms and repercussions [42]. Thus, if someone in the family is aware of symptoms, they are more likely to prevent them from worsening and report them promptly to healthcare providers [43].
In our regression analysis, patients in urban areas perceive more discomfort from diabetes symptoms than their rural counterparts. In which urban men perceive higher discomfort than urban women. The rural–urban variation in discomfort caused by the symptoms may be attributed to the rural–urban disparity in India’s standard of living [44]. Furthermore, with increasing age, discomfort from diabetes symptoms showed a disparate pattern among women and men, whereas women aged 61 and above perceived more discomfort than their counterparts. The literature also suggests that older women report worse health than men of all age groups [45]. Hence, relevant policy frameworks in this context are needed for both women and men, as they have different health needs outcomes [46]. At the same time, developing policies, religion, and social categories must be addressed because different genders perceive different levels of discomfort in these categories. A study has shown a positive correlation between good health and higher income [47]. In our research, with increasing wealth, discomfort from diabetes symptoms showed an irregular pattern among women and men. Therefore, examining these variables is vital before developing diabetes prevention interventions.
Meanwhile, educated people can better deal with health concerns [48]. Therefore, across the different education levels, literate patients in our study (including up to class 10 and 11–above categories) are less likely to perceive discomfort from diabetes symptoms. However, in all literacy categories, women cope with more significant discomfort from the symptoms than men. It implies that educated women talk about their health more comfortably than non-educated women [49].
As a result, our findings will assist policymakers in considering the aforementioned socio-economic determinants via a gender lens when establishing diabetes preventive programs. Agencies collecting big data should strengthen this study by integrating a gender component and diabetes types (type I, type II, gestational diabetes, etc.) in data collection. Additionally, including data on the date of the disease’s diagnosis and symptom pattern will provide a more accurate picture of diabetes. It can be initiated through the primary health care system, where they may develop and oversee diabetes management programs in each community through early diabetes diagnosis and tracking patient symptoms.
Conclusions
Our findings are important from a policy perspective as they showed gender differences in diabetes symptoms and their perceived severity and discomfort. We may conclude that in addition to sex differences in diabetes symptoms, gender and gender roles are crucial in defining how a person perceives the same symptom in various ways. Moreover, the discomfort perceived by any patient due to symptoms is mainly associated with socio-demographic variables. As a result, we recommend that a gender component in research, planning, and policymaking is required to reduce the diabetes burden in India.
Limitations
Like other studies, this analysis also has some limitations. The research could not extend its analysis to all Indian states due to a lack of resources. Additionally, this study was primarily based on socio-economic information gathered from patients previously diagnosed with diabetes. This signifies that no biological examinations were performed throughout the survey. This study could not extend its analysis to type I, type II, and gestational diabetes separately because during data collection, patients could not distinguish and explain their type of diabetes.
Furthermore, we acknowledge that the study was limited to just five orders of occurrence of diabetes symptoms. The investigation was also time-bound and analyzed the cases from November 2020 to February 2021 and from March 2021 to June 2021. Despite the limitations highlighted above, this study will help policymakers undertake extensive research on the symptoms of diabetes patients among both genders. It will help in the early detection of diabetes and reduce the overall burden due to diabetes in the country.
Acknowledgements
The authors are grateful to all the patients with diabetes who participated in this study.
Author contributions
RT and SR conceived the idea. SR performed the statistical analysis, and SR prepared the initial draft of the manuscript. Both authors revised the manuscript. Both authors read and approved the final manuscript.
Funding
There is no funding involved in this study.
Availability of data and material
The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Code availability
Code for data cleaning and analysis is provided as part of the replication package and is available from the corresponding author.
Declarations
Conflict of interest
The authors do not have any conflict of interest.
Ethical committee approval
The authors have not conducted any experiments on human or animal subjects in this study.
Consent to participate
Data were collected after obtaining the informed consent of the patients. Field enumerators explained the purpose of the data collection to the subjects and got their approval before proceeding with the data collection.
Consent for publication
All the authors consented to publish in this journal.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Code for data cleaning and analysis is provided as part of the replication package and is available from the corresponding author.