Research shows that men are at greater risk of serious health effects from diabetes than women

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 and 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 have had diabetes for more or less than 10 years, the findings show.

The global prevalence of diabetes is similar in men and women, and is expected to rise to 783 million by 2045, the researchers note.

But while cardiovascular disease is more common in men, it is generally not clear whether this sex difference is evident in the incidence of the complications associated with diabetes, the researchers say. It’s also not clear whether the length of time one lives with diabetes can have an impact, they add.

To investigate this further, the researchers used 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 (NSW).

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

These include cardiovascular diseases – ischemic 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 amputations; and kidney problems – acute renal failure, chronic kidney disease, chronic renal failure, dialysis and kidney transplant.

Nearly half of the group was between 60 and 74 years old, and more than half (57%; 14,697) were men, a greater proportion of whom were overweight (39% versus 29% of women) and had a history of heart disease had.

Although a similar percentage of men and women were current smokers, a greater percentage of men were former smokers: 51% versus 29% of women.

Of the 19,277 (75%) people with diabetes whose age was recorded at diagnosis, 58% had lived with the disease for less than ten years and 42% had lived with it for ten years or more.

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

Over an average monitoring period of 10 years, and taking into account age, 44% of men experienced a cardiovascular disease complication, while 57% had eye complications. Similarly, 25% of men had leg/foot complications and 35% had kidney complications. The corresponding figures for women were 31%, 61%, 18% and 25% respectively.

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

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

While the number of complications increased in tandem with the number of years men and women lived with diabetes, the gender difference in the number of complications persisted.

As an explanation, the researchers point out that the men in the study more often had known risk factors. Men are also less likely to change their lifestyle, take preventive medications or have health checks to reduce their risks, they suggest.

This is an observational study and as such no firm conclusions can be drawn about causal factors, with people with a history of complications being excluded from the study. And no information was available on potentially influential factors, such as diabetes medications and control of glucose, blood fat and blood pressure.

But based on their findings, the researchers suggest: “For every 1,000 people with diabetes, our findings suggest that on average, 37, 52, 21 and 32 people will develop cardiovascular, eye, lower limb and kidney complications each year.”

Although the risks of complications are lower in women with diabetes, they are still high, the researchers point out.

And they conclude: “Although men with diabetes are at greater risk of developing complications, esp [cardiovascular disease]complications of the kidneys and lower extremities, the rate of complications is high in both sexes.

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

“Further research into the mechanisms underlying the observed sex differences in diabetes complications is needed to inform targeted interventions.”