Men prone to more severe diabetic foot ulcers disease compared to women

DFU, with an annual incidence of 0.2 to 11 %, are longstanding diabetes complications associated strongly with peripheral arterial disease, neuropathy and foot deformity.

19 to 34% of people with diabetes develop DFU. The condition has morbidity and risk of lower limb amputation, severely impacting the patient’s quality of life and increasing the burden and cost to the health care system.

Sex strongly influences foot care behaviours, and there lies a difference in how men and women care for themselves and manage diabetes to prevent such complications. There should be a better understanding in a sex-specific manner.

Considering this, researchers identified sex differences in co-morbidities, referral pattern, ulcer severity, and outcome DFU patients treated in Belgian multidisciplinary diabetic foot clinics.

They included 1,771 patients with moderate to severe DFU and used the Generalized Estimating Equation model and Cox proportional hazards regression models.

The study summary includes the following:

• There were 72 % of male patients in the study.
• Men have deeper ulcers that probe to bone and are infected deeply.
• Most men have previous lower limb revascularization, while women have renal insufficiency.
• Smoking is more common in men than women.
• No differences in presentation delay were reported.
• Women have a 26% higher chance of healing than men without major amputation, and the hazard ratio is 1.258.

The study’s strength includes “real-world” observations.

The limitations are the study included only moderate to severe DFU; no data was recorded on BMI, glycated hemoglobin, lipid status, socio-economic status and lifestyle profile.

Concluding further, females have higher chances of ulcer healing.

Sex is an important determining factor to be considered in preventive and therapeutic strategies for managing DFU.

Further reading:

Vanherwegen AS, Lauwers P, Lavens A, Doggen K, Dirinck E; Initiative for Quality Improvement and Epidemiology in multidisciplinary Diabetic Foot Clinics (IQED-Foot) Study Group. Sex differences in diabetic foot ulcer severity and outcome in Belgium. PLoS One. 2023 Feb 16;18(2):e0281886. doi: 10.1371/journal.pone.0281886.