According to a study published online November 2 in the journal Endocrine, diabetes-related foot complications are more prevalent in men, and this at-risk group should be provided with additional attention and aggressive treatment.
In a retrospective study, a team of Brazilian researchers evaluated medical records of 496 patients with an established foot at risk or diabetes-related foot complications, based on age, gender, type and duration of diabetes, foot-at-risk classification, and the presence of deformities, ulceration, and amputation. The average age of the cohort was 60.2 years and 48.6 percent were men. Type 2 diabetes was the most prevalent at 94 percent, and the average diabetes duration was 16.8 years. About 80 percent of the patients were treated with insulin and 67.3 percent also received oral medication. At their last foot clinic visit, 45.9 percent of the cohort presented with diabetes-related foot deformities, 25.3 percent presented with foot ulceration, and 12.9 percent had undergone amputation. Regarding foot-at-risk classifications, 92.9 percent of the cohort had diabetes-related neuropathy, about 30 percent had neuroischemic disease, and 7.1 percent had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy.
The researchers found that diabetes-related deformities were associated with an increased prevalence in patients with neuroeschemic disease and neuropathy when compared to the ischemic-only group (46 percent and 48 percent versus 22 percent, respectively), regardless of age, gender, and diabetes duration or type. Men more than women (33 percent versus 18 percent) and those with Type 1 rather than Type 2 diabetes (41 percent versus 24 percent) were more likely to experience ulceration. However, male gender only remained as a significant predictor for ulceration in the multivariate analysis. Amputation was also more significant in men than women (20 percent and 7 percent, respectively) as well as in patients with neuroischemic disease as compared to patients with neuropathy or ischemic disease alone (21 percent versus 9 percent and 6 percent, respectively).
Part of the gender discrepancy, the researchers said, is attributable to better wound care in women, as men are more commonly involved in heavy physical work activities and deal with more social pressure to provide the family income and thus not miss work.
“We thus believe that older men, presenting combined risk factors should be a group receiving more special attention and aggressive treatment in the foot clinic, due to their potentially worse evolution,” the researchers concluded.
