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Gender difference as the risk of diabetic foot ulcers in T2DM patients: a meta-analysis

  • Xiaogang Hu1,†
  • Runfang Kang2,†
  • Ling Chen1,*,
  • Xiaopeng Hu3

1Department of Geriatric, Lishui Second People’s Hospital, 323000 Lishui, Zhejiang, China

2Department of Integrated Traditional Chinese and Western Medicine Surgery, Lishui Second People’s Hospital, 323000 Lishui, Zhejiang, China

3Department of Pharmacy, Huangshi Fifth People’s Hospital, 435000 Huangshi, Hubei, China

DOI: 10.22514/jomh.2024.002 Vol.20,Issue 1,January 2024 pp.1-6

Submitted: 01 November 2023 Accepted: 01 December 2023

Published: 30 January 2024

*Corresponding Author(s): Ling Chen E-mail:

† These authors contributed equally.


To investigate the gender difference as a risk factor of diabetic foot ulcer (DFU) in diabetes mellitus type 2 (T2DM) patients. The online databases including China National Knowledge Infrastructure (CNKI), Wanfang, China Biomedical Literature, PubMed, Embase, Web of Science, and Cochrane Library were searched. The retrospective and prospective studies published on the gender difference as risk factor of DFU were accessed from the databases and analyzed by the STATA software. Two prospective and 7 retrospective studies involving 4399 DFU patients were included. The results exhibited that being male (odd ratio (OR) = 1.74, 95% Confidence interval, confidence interval (CI): 1.55–1.96, p = 0.0001) was a statistically significant risk factor of DFU in T2DM patients. Other risk factors were the age of >60 years (OR = 3.12, 95% CI: 2.16–4.49, p = 0.0001), smoking (OR = 4.32, 95% CI: 3.13–5.68, p = 0.0001), hypertension (OR = 2.18, 95% CI: 1.39–3.87, p = 0.0001), cerebrovascular event (OR = 2.16, 95% CI: 1.88–3.98, p = 0.0001), coronary artery disease (OR = 1.16, 95% CI: 1.05–1.96, p = 0.0001), chronic renal failure (OR = 2.21, 95% CI: 1.54–2.79, p = 0.001), and Glycosylated hemoglobin (HbA1c) ≥7 (OR = 3.56, 95% CI: 2.27–4.43, p = 0.001). Furthermore, insulin treatment was the protective factor of DFU in male (OR = 0.66, 95% CI: 0.38–0.93, p = 0.001) and female (OR = 0.44, 95% CI: 0.27–0.83, p = 0.003) T2DM patients. Male, age >60 years, smoking, hypertension, coronary artery disease, chronic renal failure, and HbA1c ≥7 were the risk factors of DFU in T2DM patients. The publicity and awareness regarding these risk factors should be strengthened in the future clinical practice. Regular screening of high-risk groups be carried out for early detection and treatment.


Gender difference; Risk factor; Diabetic foot ulcers; Meta-analysis

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Xiaogang Hu,Runfang Kang,Ling Chen,Xiaopeng Hu. Gender difference as the risk of diabetic foot ulcers in T2DM patients: a meta-analysis. Journal of Men's Health. 2024. 20(1);1-6.


[1] Yang Y, Luan Y, Feng Q, Chen X, Qin B, Ren K, et al. Epigenetics and beyond: targeting histone methylation to treat type 2 diabetes mellitus. Frontiers in Pharmacology. 2022; 12: 807413.

[2] Shojima N, Yamauchi T. Progress in genetics of type 2 diabetes and diabetic complications. Journal of Diabetes Investigation. 2023; 14: 503–515.

[3] Khunti K, Mathieu C, Torbeyns B, Del Prato S, Heine R, Colhoun H, et al. Diabetes registries and high-quality diabetes care. The Lancet Diabetes & Endocrinology. 2023; 11: 70–72.

[4] Dao L, Choi S, Freeby M. Type 2 diabetes mellitus and cognitive function: understanding the connections. Current Opinion in Endocrinology, Diabetes & Obesity. 2023; 30: 7–13.

[5] Bekele F, Chelkeba L. Amputation rate of diabetic foot ulcer and associated factors in diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: prospective observational study. Journal of Foot and Ankle Research. 2020; 13: 65.

[6] Wang C, Mai L, Yang C, Liu D, Sun K, Song W, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer. BMC Endocrine Disorders. 2016; 16: 38.

[7] Eneroth M, Larsson J, Apelqvist J. Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis. Journal of Diabetes and its Complications. 1999; 13: 254–263.

[8] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology. 2010; 25: 603–605.

[9] Lin C, Hsu L, Chen C, Yeh J, Sun J, Lin C, et al. C-reactive protein as an outcome predictor for percutaneous transluminal angioplasty in diabetic patients with peripheral arterial disease and infected foot ulcers. Diabetes Research and Clinical Practice. 2010; 90: 167–172.

[10] Akinci B, Yener S, Yesil S, Yapar N, Kucukyavas Y, Bayraktar F. Acute phase reactants predict the risk of amputation in diabetic foot infection. Journal of the American Podiatric Medical Association. 2011; 101: 1–6.

[11] Aziz Z, Lin WK, Nather A, Huak CY. Predictive factors for lower extremity amputations in diabetic foot infections. Diabetic Foot & Ankle. 2011; 2: 7463.

[12] Saltoglu N, Yemisen M, Ergonul O, Kadanali A, Karagoz G, Batirel A, et al. Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey. Clinical Microbiology and Infection. 2015; 21: 659–664.

[13] Ferreira L, Carvalho A, Carvalho R. Short-term predictors of amputation in patients with diabetic foot ulcers. Diabetes & Metabolic Syndrome. 2018; 12: 875–879.

[14] Peled S, Pollack R, Elishoov O, Haze A, Cahn A. Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot. The Journal of Clinical Endocrinology & Metabolism. 2019; 104: 5445–5452.

[15] Aziz F, Reichardt B, Sourij C, Dimai H, Reichart D, Köhler G, et al. Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014–2017: a retrospective analysis of health insurance database. Diabetes Research and Clinical Practice. 2020; 170: 108477.

[16] Gandhi SK, Waschbusch M, Michael M, Zhang M, Li X, Juhaeri J, et al. Age- and sex-specific incidence of non-traumatic lower limb amputation in patients with type 2 diabetes mellitus in a U.S. claims database. Diabetes Research and Clinical Practice. 2020; 169: 108452.

[17] Jiang M, Gan F, Gan M, Deng H, Chen X, Yuan X, et al. Predicting the risk of diabetic foot ulcers from diabetics with dysmetabolism: a retrospective clinical trial. Frontiers in Endocrinology. 2022; 13: 929864.

[18] Borderie G, Foussard N, Larroumet A, Blanco L, Barbet-Massin M, Ducos C, et al. Diabetic retinopathy relates to the incidence of foot ulcers and amputations in type 2 diabetes. Diabetes/Metabolism Research and Reviews. 2023; 39: e3605.

[19] Sharma R, Sharma SK, Mudgal SK, Jelly P, Thakur K. Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials. Scientific Reports. 2021; 11: 2189.

[20] Ramachandran V, Mohanasundaram T, Karunakaran D, Gunasekaran M, Tiwari R. Physiological and pathophysiological aspects of diabetic foot ulcer and its treatment strategies. Current Diabetes Reviews. 2023; 19: e031122210617.

[21] Rismayanti IDA, Nursalam, Farida VN, Dewi NWS, Utami R, Aris A, et al. Early detection to prevent foot ulceration among type 2 diabetes mellitus patient: a multi-intervention review. Journal of Public Health Research. 2022; 11: 2752.

[22] Li Y, Ju S, Li X, Li W, Zhou S, Wang G, et al. Characterization of the microenvironment of diabetic foot ulcers and potential drug identification based on scRNA-seq. Frontiers in Endocrinology. 2022; 13: 997880.

[23] Raghav A, Tripathi P, Mishra BK, Jeong GB, Banday S, Gautam KA, et al. Mesenchymal stromal cell-derived tailored exosomes treat bacteria-associated diabetes foot ulcers: a customized approach from bench to bed. Frontiers in Microbiology. 2021; 12: 712588.

[24] Jifar WW, Atnafie SA, Angalaparameswari S. A review: matrix metallopeptidase-9 nanoparticles targeted for the treatment of diabetic foot ulcers. Journal of Multidisciplinary Healthcare. 2021; 14: 3321–3329.

[25] Rathnayake A, Saboo A, Malabu UH, Falhammar H. Lower extremity amputations and long-term outcomes in diabetic foot ulcers: a systematic review. World Journal of Diabetes. 2020; 11: 391–399.

[26] Crawford F, Chappell FM, Lewsey J, Riley R, Hawkins N, Nicolson D, et al. Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model. Health Technology Assessment. 2020; 24: 1–198.

[27] Haycocks S, Cameron R, Edge M, Budd J, Chadwick P. Implementation of a novel mHealth application for the management of people with diabetes and recently healed foot ulceration: a feasibility study. Digital Health. 2022; 8: 20552076221142103.

[28] Rovers FJ, Van Netten JJ, Busch-Westbroek TE, Aan de Stegge WB, Bus SA. Adherence to at-home monitoring of foot temperatures in people with diabetes at high risk of ulceration. To be published in The International Journal of Lower Extremity Wounds. 2022. [Preprint].

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