Men are more susceptible to the serious consequences of diabetes than women

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

Rates of cardiovascular disease, complications of the legs, feet and kidneys, and vision-threatening eye diseases such as diabetic retinopathy are higher in men, regardless of how long they have had diabetes - less than or more than 10 years, the study shows.

The global prevalence of diabetes is roughly equal among men and women and is projected to reach 783 million by 2045, according to researchers.

Although cardiovascular disease is more common in men overall, it is unclear whether this gender difference translates into diabetes-related complications, the researchers note. It is also unclear whether the length of time people live with diabetes affects these differences, they add.

To further explore this question, the researchers used survey data from the 45 and Up Study, Australia, a large prospective study of 267,357 people over 45 years of age living in New South Wales (NSW).

The data were linked to the medical records of 25,713 people, all of whom had either type 1 or type 2 diabetes, to track the development of major diabetes-related health problems.

These problems include cardiovascular disease ( coronary artery disease, mini-stroke or transient ischemic attack, stroke, heart failure, diabetic cardiomyopathy); eye problems (cataracts, diabetic retinopathy); leg and foot problems ( peripheral neuropathy (nerve damage), ulcers, cellulitis, osteomyelitis (bone inflammation), peripheral vascular disease (poor circulation), and minor and major amputations); and kidney problems ( acute kidney failure, chronic kidney disease, chronic kidney failure, dialysis, and kidney transplant).

Almost half of the group were aged 60 to 74 years, and more than half (57%; 14,697) were men, most of whom were overweight (39% vs. 29% in women) and had a history of heart disease.

Although roughly equal proportions of men and women were current smokers, more men were former smokers: 51% versus 29% of women.

Of 19,277 (75%) people with diabetes whose age at diagnosis was recorded, 58% had lived with the disease for less than 10 years and 42% had lived with the disease for 10 or more years.

Men had higher rates and were at greater risk of diabetes-related complications.

Over a mean follow-up period of 10 years and after adjusting for age, 44% of men experienced a cardiovascular complication, and 57% experienced an eye complication. Also, 25% of men experienced a leg/foot complication, and 35% experienced a kidney complication. The corresponding figures for women were 31%, 61%, 18%, and 25%.

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

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

Although complication rates increased with increasing duration of life with diabetes in both men and women, gender differences in complication rates persisted.

The researchers note that men in the study were more likely to have known risk factors. They may also be less likely to make lifestyle changes, take preventative medications, or get health checkups to reduce their risks, they suggest.

This is an observational study and as such no definitive conclusions can be made about causal factors, and people with a history of complications were excluded. Information on potentially influencing factors such as diabetes medications, glucose control, blood fats and blood pressure was also not available.

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

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

And they conclude: "Although men with diabetes are at greater risk of developing complications, particularly cardiovascular, renal and lower extremity disease, the incidence of complications is high in both sexes.

“A similar difference between the sexes for people with shorter and longer diabetes duration highlights the need for targeted screening and complication 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."