Men should be considered for aggressive treatment for foot complications associated with diabetes, such as ulceration and amputation, say researchers.
The study, published in Endocrine, indicates that male gender may be a significant predictor for diabetic foot outcomes, alongside the well-characterized risk factors for diabetic neuropathy and peripheral vascular disease.
"This difference in gender 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 keep providing the family income," suggest Maria Candida Ribeiro Parisi (University of Campinias, Brazil) and co-workers.
"Also important, absenteeism is higher among men. These issues cause ulcerations to take longer to recover, being more likely to present at a consult at any given moment, and also more likely to terminate in amputation," they emphasize.
The team reviewed medical records for 496 patients with a diagnosis or risk factors for diabetic foot. The majority of patients had Type 2 diabetes (94%), 48.6% of patients were male, and the average diabetes duration was 16.8 years. Most of the patients were treated with insulin (80.8%), and 67.3% also received oral drugs.
At the last foot clinic visit, 45.9% of patients had diabetic foot deformity, 25.3% had foot ulceration, and 12.9% had undergone amputation. Two-thirds (67.2%) of patients had no present or past history of ulceration or amputation.
Of note, 92.9% of the patients had diabetic neuropathy, 30% had neuro-ischemic disease, and 7.1% had only ischemic disease. Neuropathy with no evidence of arteriopathy was reported in 62% of patients.
Patients with neuro-ischemic symptoms or neuropathy alone were significantly more likely than patients with only ischemic symptoms to have foot deformity (46 and 48 vs 22%), regardless of age, gender, and diabetes duration or type.
Ulceration was significantly more common in men than women (33.0 vs 18.0%), and male gender was the only significant risk factor for ulceration in multivariate analysis (odds ratio [OR]=2.15).
Amputation was also significantly more common in men than women (20 vs 7%), and in patients with neuro-ischemic disease than neuropathy or ischemic disease alone (21 vs 9 and 6%, respectively), with multivariate analysis ORs of 3.44 and 4.6, respectively, for these risk factors.
"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," Parisi et al conclude.
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