The impact of living with type 2 diabetes on women's health and wellbeing during their reproductive years

Background: Globally, sixty-million women of reproductive age live with diabetes, with most having type 2 diabetes (T2DM). Women may be exposed to increased potential adverse effects of T2DM with regard to their health and well-being, including pregnancy-related complications, disordered eating, diabetes distress, and stigma. However, limited research exists exploring the health needs and experiences of these women. Aim: To understand how living with T2DM affects younger women's health perceptions and experiences during their reproductive years in order to identify their health needs and inform future interventions and care pathways to improve their health and wellbeing. Methods: The study, informed by the Medical Research Council (MRC) framework, consisted of three stages for which a mixed method approach was used. Stage-1 included a mixed-methods systematic review exploring the impact of living with T2DM on women's health and wellbeing during their reproductive years (published paper 1). Stage-2 was a qualitative study design using semi-structured interviews, exploring the health needs, experiences,and views of women aged 18-45, and therefore of reproductive age, living withT2DM (published paper 2). Stage-3 included a cross-sectional study evaluating the relationships between psychosocial factors identified in the qualitative study and self-management behaviours among women of reproductive age living with T2DM. Participants completed validated questionnaires using an electronic survey to assess fatigue (FSS), disordered eating (SCOFF-5), stigma (DSAS-2),diabetes distress (DDS), anxiety (GAD-7), and self-management behaviours(SDSCA). Socio-demographic and diabetes history were also recorded. Eligibility criteria for stage-2 and -3 were women with T2DM, aged 18-45, living in either the UK or Türkiye who were able to speak and understand English or Turkish. • A mixed methods systematic review consisted of 32 studies, including 21 quantitative, 10 qualitative, and one mixed-method study from eleven different countries, along with one multinational country including 11 Latin American countries. This review found wide-ranging health issues affecting women of reproductive age with T2DM,specifically cardiovascular issues, psycho social issues such as diabetes distress and stigma, and reproductive health issues such as sexual dysfunction and early menopause. However, this review identified an evidence gap in the literature, highlighting a lack of understanding of the diabetes experiences and health needs of young women of reproductive age. Furthermore, it reported a notable absence of intervention studies for this population, suggesting the development of more targeted and effective interventions. Therefore, this review has illustrated the need for further research to comprehensively explore the experiences of and views on living with T2DM in their reproductive years, identifying the health needs of these young women to inform the strategies and future interventions to improve their health and wellbeing. • The qualitative study involved 36 women living in the UK and Türkiye with a median age of 37 years (age range 20-45 years). It identified two overarching themes, namely i) Perception of Self and Identity and ii) Poor Orientation of T2DM Care towards younger women's health needs. Women's perceptions of self and their disrupted identity exposed the gender and age-related health issues of fear surrounding fertility and pregnancy and the emotional burden of diabetes management. Women reported that their interactions with healthcare professionals were unhelpful because they were not age- and gender appropriate or focused. The women voiced ideas for enhancing current care, in particular, the need for more psycho social and peer-based support. The study described significant levels of emotional burden and impacts on younger women's general health and diabetes-specific self-care and revealed an evidence gap surrounding the prevalence of these experiences. • The cross-sectional study included ninety-two women with T2DM from the UK and Türkiye with a mean age of 35.5 years (SD = 7.2; range 19-45 years). Family history of T2DM was reported by 70% of participants and 47% had a diabetes duration of between 1-5 years. Seventy women (76%) reported having not attended a diabetes education course. Ninety-two percent of women reported disordered eating behaviours, and 65% reported diabetes distress. Fatigue was reported by 57% of women, stigma by 53%, and anxiety by 24%. This study highlighted a high prevalence of psychosocial factors identified in the qualitative study. The highly prevalent disordered eating was negatively associated with diabetes distress and anxiety but no correlation between self-management and disordered eating behaviours were identified. Recruiting this population was challenging and did not reach our target. This limited the opportunity for subgroup analysis based on nationality. Conclusion: This thesis provides novel evidence about the health needs, experiences, and views of young women of reproductive age living with T2DM. The care provided to this population of women needs to ensure that their wider reproductive health needs are optimally considered in the planning and delivery of care. Evidence from this thesis highlights areas where future interventions are required to improve women's health and wellbeing.