Divorced men with type 1 or 2 diabetes are at the highest risk of having some or all of their feet and legs amputated because of the disease, research has found.
A study due to be presented at October’s annual meeting of the European Association for the Study of Diabetes in Hamburg, Germany, has concluded that, among people with type 1 and type 2 diabetes, being divorced is associated with a two-thirds higher risk of lower limb amputation (LLA) (or amputations below the knee level) compared with being married. Being male is associated with a 57% higher risk compared with being female.
While the reasons for this are likely to vary, changes in lifestyle and diet habits following a divorce, especially taking less exercise, not eating as well and becoming more socially isolated, could all be factors, it concluded.
The study, led by Dr Stefan Jansson of Örebro University in Sweden, found that deterioration in the structure of both large and small blood vessels was common among people with diabetes, especially among those who are less adherent to diabetes medications to lower blood sugar, blood fats and blood pressure.
Overall, rates of LLA have been declining for a number of years, as diabetes treatment and control has improved.
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The authors used data from the Swedish national diabetes register to identify all individuals 18 years or older with an incident diabetes diagnosis and no previous amputation from 2007 to 2016.
These individuals were then followed from the date of the diagnosis to amputation, emigration, death, or the end of the study in 2017, whichever occurred first. Most (98%) had type 2 diabetes and 2% type 1.
In all, some 66,569 individuals were analysed, of whom 133 had an amputation during the median follow-up of four years. Computer modelling was used to identify associations of the potential risk factors have with LLA incidence.
The authors found that being divorced compared with being married was associated with a 67% higher risk of LLA, and being male compared with being female was associated with a 57% higher risk of LLA. Each year of additional age was associated with an 8% increased risk of LLA.
The higher risk of LLA in divorced people may be because of changes in self-care and food habits observed in people when they divorce, and so are more likely to be living alone.
Specifically with men, this was often related to more social isolation with a secondary effect of low physical activity.
“This study found a higher risk for LLA among people with higher age, male sex, who were divorced, who had a higher foot risk group, who were on insulin treatment, lower physical activity levels, and those who were smoking. Obesity was associated with a lower risk for LLA. Thus, these variables may have important roles in LLA risk among individuals with diabetes,” the authors argued.
“Lifestyle variables have a strong association with LLA, and an increase in physical activity, avoidance of being underweight and smoking cessation may be impactful interventions to reduce the risk of LLA. Early lower limb complications after a diabetes diagnosis or complications present at diagnosis are warning signs, and these patients should be given extra attention,” they added.
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