The influence of gender as a risk factor in diabetic foot ulceration

Objective. In a previous large, prospective trial, 29% of all patients with diabetes were shown to ulcerate over a 30-month period. The influence of gender on foot ulcers has been controversial, with some studies demonstrating male gender as a risk factor, while other studies have shown no difference. The authors hypothesized that gender may pose a significant risk factor for the development of diabetic foot ulcers.

A total of 248 patients with diabetes were enrolled in a 30-month, multicenter, prospective study. There were 124 men (M) and 124 women (W). There were no differences between M and W in age (59 ± 12 years [mean ± SD]) versus 57 ± 13), duration of diabetes mellitus (15 ± 11 years versus 13 ± 11), or body mass index (BMI) (30.0 ± 7.7 versus 31.3 ± 6.2). The following known risk factors for diabetic foot ulceration were measured in both groups: Neuropathy Disability Score (NDS), Vibration Perception Threshold (VPT), Semmes Weinstein Monofilament (SWM), plantar peak foot pressures, and subtalar joint (STJ) and first metatarsal joint (MTPJ) mobility.

Men had higher NDS (13 ± 8 versus 8 ± 7, P < 0.0001), VPT (36 ± 17 V versus 23 ± 16, P < 0.0001), SWM (5.9 ± 1.4 versus 5.9 ± 1.3, P <0.0001), and plantar peak foot pressures (6.4 ± 3.4 kg/cm2 versus 5.0 ± 2.3, P < 0.0001), while women had higher MTPJ mobility (69 ± 24 degrees versus 77 ± 23, P < 0.0001) and STJ mobility (22 ± 10 degrees versus 26 ± 8, P < 0.0001). Plantar foot ulceration developed in 49 (40%) men compared to 24 (19%) women (P <0.0001). However, when men and women were analyzed separately, univariate logistical regression analysis yielded similar odds ration (OR) in both groups for high NDS (≥ 5, M 6.1, W 8.3), high VPT (≥ 25 V, M 6.0, W 8.9), SWM (M 6.6, W 3.7), high foot pressures (≥ 6 kg/cm2, M 2.7, W 3.0), and MTPJ mobility (M 0.96, W 0.97).

While women have a lower risk than men for foot ulceration, this appears to be the result of less severe neuropathy, increased joint mobility, and lower foot pressures. However, once neuropathy or other risk factors are present, women were found to have the same risk of developing a foot ulceration as men. Therefore, women with risk factors for foot ulceration should be considered to be at equal risk as men for developing future problems.