Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Data Analysis
3. Results
3.1. Demographic and Clinical Characteristics
3.2. T1D Management
3.3. Prevalence of Depression and Anxiety
3.4. Depression Symptoms
3.5. Anxiety Symptoms
3.6. Risk Factors of Perceived Severe Depression and Anxiety
4. Discussion
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | All | Males (n = 303) | Females (n = 770) | p-Value |
---|---|---|---|---|
Age (years) | 26.4 ± 8.9 | 28.3 ± 11.1 | 25.6 ± 6.5 | <0.001 |
BMI (kg/m2) | 24.4 ± 5.5 | 25.1 ± 6.5 | 24.1 ± 5.0 | 0.003 |
Obesity status | <0.001 | |||
Underweight | 175 (16.9) | 54 (18.8) | 121 (16.2) | |
Normal Weight | 461 (44.5) | 107 (37.3) | 354 (47.3) | |
Overweight | 264 (25.5) | 71 (24.7) | 193 (25.8) | |
Obese | 135 (13.0) | 55 (19.2) | 80 (10.7) | |
Diabetes duration | <0.001 | |||
<1 year | 83 (7.7) | 31 (10.2) | 52 (6.8) | |
1–5 years | 233 (21.7) | 79 (26.1) | 154 (20) | |
6–10 years | 183 (17.1) | 61 (20.1) | 122 (15.8) | |
>10 years | 574 (53.5) | 132 (43.6) | 442 (57.4) | |
Residence | 0.88 | |||
Central | 515 (48.0) | 141 (46.5) | 374 (48.6) | |
West | 289 (27.0) | 85 (28.1) | 204 (26.5) | |
East | 127 (11.8) | 39 (12.9) | 88 (11.4) | |
North | 65 (6.1) | 16 (5.3) | 49 (6.4) | |
South | 76 (7.1) | 22 (7.3) | 54 (7.0) | |
Education | 0.17 | |||
High school | 345 (32.2) | 107 (35.3) | 238 (30.9) | |
University | 646 (60.2) | 169 (55.8) | 477 (61.9) | |
Postgraduate | 82 (7.6) | 27 (8.9) | 55 (7.1) | |
Physical activity (min/week) | 97.8 ± 129.6 | 122.1 ± 155.3 | 88.2 ± 116.7 | <0.001 |
Physical activity | <0.001 | |||
<150 min/week | 833 (77.8) | 214 (70.6) | 619 (80.6) | |
≥150 min/week | 238 (22.2) | 89 (29.4) | 149 (19.4) | |
Income | 0.19 | |||
<5000 SAR | 197 (18.4) | 60 (19.8) | 137 (17.8) | |
5000–10,000 SAR | 293 (27.3) | 76 (25.1) | 217 (28.2) | |
11,000–20,000 SAR | 247 (23.0) | 78 (25.7) | 169 (21.9) | |
21,000–30,000 SAR | 65 (6.1) | 21 (6.9) | 44 (5.7) | |
31,000–40,000 SAR | 38 (3.5) | 11 (3.6) | 27 (3.5) | |
>40,000 SAR | 37 (3.4) | 14 (4.6) | 23 (3.0) | |
I don’t know | 196 (18.3) | 43 (14.2) | 153 (19.9) | |
Diabetes complications | 0.11 | |||
None | 724 (71.0) | 194 (69.5) | 530 (71.5) | |
I don’t know | 133 (13.0) | 35 (12.5) | 98 (13.2) | |
Neuropathy | 44 (4.3) | 12 (4.3) | 32 (4.3) | |
Nephropathy | 29 (2.8) | 7 (2.5) | 22 (3.0) | |
Retinopathy | 80 (7.5) | 25 (9.0) | 55 (7.4) | |
Diabetic foot | 4 (0.4) | 1 (0.4) | 3 (0.4) | |
Coronary artery disease | 6 (0.6) | 5 (1.8) | 1 (0.1) | |
Other comorbidities | 0.008 | |||
None | 866 (82.6) | 265 (88.6) | 601 (80.1) | |
Hypothyroidism | 121 (11.5) | 18 (6.0) | 103 (13.7) | |
Celiac disease | 49 (4.7) | 12 (4.0) | 37 (4.9) | |
Vitiligo | 11 (1.0) | 3 (1.0) | 8 (1.1) | |
Addison’s disease | 2 (0.2) | 1 (0.3) | 1 (0.1) |
Parameter | All | Males (n = 303) | Females (n = 770) | p-Value |
---|---|---|---|---|
Last known HbA1c | 0.10 | |||
<7.0% | 388 (36.2) | 103 (34.0) | 285 (37.0) | |
7.1–8.0% | 329 (30.7) | 86 (28.4) | 243 (31.6) | |
8.1–9.0% | 151 (14.1) | 45 (14.9) | 106 (13.8) | |
>9.0% | 163 (15.2) | 50 (16.5) | 113 (14.7) | |
I don’t know | 42 (3.9) | 19 (6.3) | 23 (3.0) | |
Visited diabetes education clinic last year | 714 (66.5) | 199 (65.7) | 515 (66.9) | 0.72 |
Benefit from diabetes education clinic visit | 0.03 | |||
Above average | 327 (30.5) | 106 (35.0) | 221 (28.7) | |
Average | 277 (25.8) | 61 (20.1) | 216 (28.1) | |
Less than average | 247 (23.0) | 67 (22.1) | 180 (23.4) | |
No benefit | 222 (20.7) | 39 (22.8) | 153 (19.9) | |
Education resource preferences | 0.04 | |||
Diabetes education clinic | 90 (8.4) | 35 (11.9) | 55 (7.3) | |
Attending physician | 123 (11.7) | 43 (14.6) | 80 (10.6) | |
Diabetes groups on social media | 75 (7.1) | 23 (7.8) | 52 (6.9) | |
Friends with diabetes | 40 (3.8) | 11 (3.7) | 29 (3.8) | |
Own reading of scientific sources | 69 (6.6) | 20 (6.8) | 49 (6.5) | |
Multiple education sources | 655 (62.3) | 163 (55.3) | 492 (65.0) | |
Advised carbohydrate counting | 0.14 | |||
Yes, but no referral to dietician | 244 (22.7) | 64 (21.1) | 180 (23.4) | |
Yes, and referred to dietician | 565 (52.7) | 152 (50.2) | 413 (53.6) | |
No | 264 (24.6) | 87 (28.7) | 177 (23.0) | |
Practices carbohydrate counting | 520 (48.5) | 112 (37.0) | 408 (53.0) | <0.001 |
Visited dietician clinic | 347 (32.3) | 74 (24.4) | 273 (35.5) | 0.001 |
Has medical insurance | 321 (30.0) | 113 (37.3) | 208 (37.2) | 0.91 |
Rejected request for CGM | 382 (46.8) | 104 (47.9) | 278 (46.4) | 0.38 |
Rejected request for insulin pump | 327 (51.8) | 80 (48.8) | 247 (52.9) | 0.210 |
Type of clinic visited for follow-ups | <0.001 | |||
Government hospital | 696 (64.9) | 173 (57.1) | 523 (67.9) | |
Private hospital | 163 (15.2) | 62 (20.5) | 101 (13.1) | |
Local clinic | 48 (4.5) | 22 (7.3) | 26 (3.4) | |
I don’t have regular follow-ups | 125 (11.6) | 11 (3.6) | 30 (3.9) | |
Type of management | 0.01 | |||
Insulin injection | 839 (78.2) | 253 (83.5) | 586 (76.1) | |
Insulin pump | 234 (21.8) | 50 (16.5) | 184 (23.9) | |
PHQ-9 score ≥ 5 | 658 (61.2) | 158 (52.1) | 500 (64.9) | 0.02 |
Overall | Males | Females | |
---|---|---|---|
Depression | |||
Minimal | 18.6 (16.3–20.9) | 21.5 (16.8–26.1) | 17.5 (14.8–20.2) |
Mild | 27 (24.3–29.6) | 24.1 (19.2–28.9) | 28.2 (25.0–31.4) |
Moderate | 15.7 (13.5–17.9) | 14.2 (10.2–18.1) | 16.4 (13.7–19.0) |
Moderately Severe | 10.5 (8.7–12.4) | 8.3 (5.1–11.4) | 11.4 (9.2–13.7) |
Severe | 8 (6.4–9.6) | 5.6 (3.0–8.2) | 9 (6.9–11.0) |
Anxiety | |||
Minimal | 24.7 (22.1–27.3) | 29.7 (24.5–34.9) | 22.9 (19.9–25.8) |
Mild | 26.7 (24.0–29.4) | 21.8 (17.1–26.5) | 28.7 (25.5–31.9) |
Moderate | 15.6 (13.4–17.8) | 14.9 (10.8–18.9) | 16 (13.4–18.6) |
Severe | 15.6 (13.4–17.8) | 10.6 (7.1–14.0) | 17.7 (15.0–20.4) |
Question | Not at All | Several Days | More Than Half the Days | Nearly Every Day |
---|---|---|---|---|
Little interest or pleasure in doing things? | 267 (29.6) | 374 (41.5) | 127 (14.1) | 133 (14.8) |
Feeling down, depressed, or hopeless? | 220 (24.4) | 405 (45.0) | 156 (17.3) | 120 (13.3) |
Trouble falling or staying asleep, or sleeping too much? | 233 (25.9) | 300 (33.3) | 173 (19.2) | 195 (21.6) |
Feeling tired or having little energy? | 125 (13.9) | 398 (44.2) | 180 (20.0) | 198 (22.0) |
Poor appetite or overeating? | 226 (25.1) | 314 (34.9) | 180 (20.0) | 181 (20.1) |
Feeling bad about yourself? | 459 (50.9) | 222 (24.6) | 87 (9.7) | 133 (14.8) |
Trouble concentrating on things? | 444 (49.3) | 265 (29.4) | 107 (11.9) | 85 (9.4) |
Moving/speaking slowly, or the opposite? | 568 (63.0) | 197 (21.9) | 73 (8.1) | 63 (7.0) |
Thoughts that you would be better off dead? | 687 (76.2) | 119 (11.1) | 44 (4.9) | 51 (5.7) |
Question | Not at All | Several Days | More Than Half the Days | Nearly Every Day |
---|---|---|---|---|
Feeling nervous, anxious, or on edge? | 113 (12.7) | 399 (44.9) | 189 (17.6) | 188 (17.5) |
Not being able to stop or control worrying? | 242 (22.5) | 326 (30.3) | 151 (17.0) | 170 (19.1) |
Worrying too much about different things? | 171 (19.2) | 353 (39.7) | 166 (18.7) | 199 (22.4) |
Trouble relaxing? | 270 (30.4) | 327 (36.8) | 159 (17.9) | 133 (15.0) |
Being so restless that it is hard to sit still? | 489 (55.0) | 235 (26.4) | 90 (10.1) | 75 (8.4) |
Becoming easily annoyed or irritable? | 170 (19.1) | 343 (38.6) | 161 (18.1) | 215 (24.2) |
Feeling afraid, as if something awful might happen? | 431 (48.5) | 239 (26.9) | 97 (10.9) | 122 (13.7) |
Severe Depression | |||
---|---|---|---|
Factor | Odds Ratio | Confidence Interval | p-Value |
Income | |||
5000–10,000 SAR | 0.38 | 0.20–0.75 | 0.005 |
11,000–20,000 SAR | 0.39 | 0.19–0.78 | 0.008 |
Diabetes complications | |||
Absence of neuropathy | 0.27 | 0.11–0.62 | 0.002 |
Benefit from diabetes education clinic visit | |||
Above average | 0.47 | 0.25–0.90 | 0.02 |
Education resource preferences | |||
Friends with T1D | 2.8 | 1.1–7.2 | 0.04 |
Practices carbohydrate counting | 0.47 | 0.30–0.75 | 0.002 |
Last known HbA1c | |||
<7.0% | 0.24 | 0.08–0.72 | 0.01 |
Rejected request for CGM | 1.88 | 1.1–3.2 | 0.02 |
Rejected request for insulin pump | 2.82 | 1.5–5.3 | 0.001 |
Severe Anxiety | |||
Gender | |||
Male | 0.61 | 0.40–0.93 | 0.02 |
Diabetes complications | |||
Absence of neuropathy | 0.38 | 0.18–0.80 | 0.01 |
Education resource preferences | |||
Own reading of scientific sources | 2.0 | 1.1–3.9 | 0.03 |
Practices carbohydrate counting | 0.54 | 0.38–0.76 | <0.001 |
Last known HbA1c | |||
<7.0% | 0.24 | 0.10–0.58 | 0.001 |
Rejected request for insulin pump | 2.36 | 1.45–3.79 | <0.001 |
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Alguwaihes, A.M. Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia. J. Clin. Med. 2025, 14, 5777. https://doi.org/10.3390/jcm14165777
Alguwaihes AM. Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia. Journal of Clinical Medicine. 2025; 14(16):5777. https://doi.org/10.3390/jcm14165777
Chicago/Turabian StyleAlguwaihes, Abdullah M. 2025. "Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia" Journal of Clinical Medicine 14, no. 16: 5777. https://doi.org/10.3390/jcm14165777
APA StyleAlguwaihes, A. M. (2025). Gender Differences in Type 1 Diabetes Management and Mental Health Burden: Findings from a National Survey in Saudi Arabia. Journal of Clinical Medicine, 14(16), 5777. https://doi.org/10.3390/jcm14165777