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Preventive ApporachesMay 15, 2024

People with diabetes need targeted complication screening and prevention strategies after diagnosis

Men are at greater risk than women of the major health effects of diabetes (types 1 and 2), suggests a long-term study published online in the Journal of Epidemiology & Community Health.

Rates of cardiovascular disease, leg, foot, and kidney complications and the sight-threatening eye disease diabetic retinopathy are all higher in men, regardless of whether they had diabetes for more or fewer than 10 years, the findings show. They also highlight the importance of targeted complication screening and prevention strategies from the time of diagnosis for both genders.

The article’s first author is Alice Gibson, who is based at the Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, at University of Sydney.

While cardiovascular disease is more common in men, overall, it’s not clear if this sex difference is apparent in the incidence of the complications associated with diabetes, say the researchers. Nor is it clear whether the length of time lived with diabetes might be influential, they add.

To explore this further, the researchers drew on survey responses from the 45 and Up Study, Australia, a large prospective study of 267,357 people over the age of 45 living in New South Wales.

Photo Credit: Shutterstock
A close-up photograph shows the feet of a with diabetic foot complications

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More men were ex-smokers

These responses were linked to medical records for a total of 25,713 people, all of whom had either type 1 or type 2 diabetes, to monitor the development of any of the major health issues associated with diabetes.

These include cardiovascular disease – ischaemic heart disease, mini stroke or TIA, stroke, heart failure, diabetic cardiomyopathy; eye problems – cataract, diabetic retinopathy; leg/foot problems – peripheral neuropathy (nerve damage), ulcers, cellulitis, osteomyelitis (bone inflammation), peripheral vascular disease (poor circulation), and minor or major amputation; and kidney problems – acute kidney failure, chronic kidney disease, chronic kidney failure, dialysis, and kidney transplant.

The similar sex difference for those with shorter compared with longer diabetes duration highlights the need for targeted complication screening and prevention strategies from the time of diabetes diagnosis [Alice Gibson et al]

Almost half of the group were aged 60 to 74, and over half (57 per cent; 14,697) were men, a higher proportion of whom were overweight (39 per cent vs 29 per cent of women) and had a history of heart disease.

Although a similar proportion of men and women were current smokers, a higher proportion of men were ex-smokers: 51 per cent vs 29 per cent of the women. 

Of the 19,277 (75 per cent) people with diabetes whose age was recorded at their diagnosis, 58 per cent had been living with the disease for less than a decade and 42 per cent had lived with it for 10 or more years.

Men at greater risk of facing complications

Men had higher rates, and were at greater risk, of the complications associated with diabetes.

Over an average monitoring period of 10 years, and after factoring in age, 44 per cent of the men experienced a cardiovascular disease complication while 57 per cent had eye complications. Similarly, 25 per cent of the men had leg/foot complications, and 35 per cent kidney complications. The equivalent figures for women were, respectively, 31 per cent, 61 per cent, 18 per cent and 25 per cent.

Overall, men were 51 per cent more likely to develop cardiovascular disease than women, 47 per cent more likely to have leg and foot complications, and 55 per cent more likely to have kidney complications. 

Although there was little difference in the overall risk of eye complications between the sexes, men were at slightly higher risk (14 per cent) of diabetic retinopathy.

While complication rates rose in tandem with the number of years lived with diabetes for both men and women, the sex difference in complication rates persisted.

By way of an explanation, the researchers point out that the men in the study were more likely to have well known risk factors. Men may also be less likely to make lifestyle changes, take preventive meds, or get health checks to lower their risks, the authors suggest.

Caveats and conclusions

As the study was observational in nature, no firm conclusions can be drawn about causal factors – added to which people with a history of complications were excluded from the study. Information on potentially influential factors, such as diabetes medications, and glucose, blood fat, and blood pressure control was not available. 

But based on their findings, Dr Gibson and colleagues suggest: ‘For every 1,000 people with diabetes, our findings suggest that an average of 37, 52, 21, and 32 people will develop cardiovascular disease, eye, lower limb, and kidney complications every year.’

While the risks of complications are lower in women with diabetes, they are still high, the researchers emphasise.

Dr Gibson and colleagues conclude: ‘Although men with diabetes are at greater risk of developing complications, in particular [cardiovascular disease], kidney and lower-limb complications, the rates of complications are high in both sexes. 

‘The similar sex difference for those with shorter compared with longer diabetes duration highlights the need for targeted complication screening and prevention strategies from the time of diabetes diagnosis.

They add: ‘Further investigation into the underlying mechanisms for the observed sex differences in diabetes complications are needed to inform targeted interventions.’

Fact file

  • the global prevalence of diabetes is similar in men and women and is projected to rise to 783 million by 2045, note Dr Gibson and colleagues.
  • the high rates of complication affecting both genders, highlights the importance of targeted complication screening and prevention strategies from the time of diagnosis
  • although no studies have examined overall lower limb complications, the risk of amputation has been shown to be greater in men than in women
  • similarly, a meta-analysis of 20 studies found that men with diabetic foot have an approximate 50 per cent increased amputation risk compared with women

To access the full version of the article – titled  Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes doi: 10.1136/jech-2023-221759 – click

Author: Ian A McMillan
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