Divorced men are at the highest risk among people with diabetes of having some or all of their feet and legs amputated because of the disease, research has found.
People with diabetes who are divorced are two-thirds (67%) more likely to have to undergo a lower limb amputation than those who are married. Men are at 57% greater risk than women of that fate.
The trends emerged from research conducted among 66,569 people with diabetes in Sweden, findings from which will be presented at a conference of specialists in the disease.
The need for lower limb amputation is a serious but common side-effect of diabetes and a risk run by people with the type 1 and type 2 forms of the disease. On average, 184 people a week in England have some part of a lower limb removed surgically to stop infection spreading and killing them. The number of people with diabetes in Britain recently reached a record high of about 5.1 million.
The authors of the study said they could not be sure why divorcees of both sexes ran such a greater risk than married people, but speculated that this “may be due to a change in self-care and food habits observed in people when they divorce and are more likely to be living alone”.
“Specifically with men, this is often related to more social isolation, with a secondary effect of low physical activity,” they added.
Lasantha Wijesinghe, a consultant vascular surgeon in England who performs lower limb amputations, said they were usually necessary because the person’s life was at risk because of sepsis, the body’s life-threatening reaction to an infection.
“Some of the people [with diabetes] that we perform a lower limb amputation on are diabetic and have no other health conditions and don’t smoke or have high blood pressure, for example. Others have diabetes but also other things such as high blood pressure or high cholesterol and smoke, the traditional risk factors for arterial disease,” he said.
“In a minor amputation we may remove a toe or several toes. But in major cases we remove the leg below, at or above the knee. If you haven’t done the amputation, the sepsis will kill the patient. So the amputation is in effect a life-saving procedure, [which is] done because there are no other antibiotics left to use and we are at the end of the road treatment-wise.”
He said the profile of those undergoing an amputation in the NHS was broadly the same as those in Sweden.
Older people are also at higher risk of an amputation, even if they have been diagnosed with diabetes only quite recently, the study found. Each year of extra age meant someone was at 8% higher risk, said the authors, who were led by Dr Stefan Jansson, of Örebro University.
Patients who are on insulin treatment, have a pre-existing foot condition such as neuropathy or who smoke are also at higher risk. But, in a surprising finding, the study concluded that obese people have a lower risk than those with a standard weight. The authors could not explain this finding but suggested it could be down to chance.
Jansson will present the results, which have not yet been peer-reviewed, at the European Association for the Study of Diabetes’ annual conference in early October.
Dr Faye Riley, the research communications manager at Diabetes UK, said: “This study identifies a range of factors that may be linked with a higher risk of amputation among people with diabetes, and raises interesting questions about how social support can influence our health behaviours and outcomes. By pinpointing which people with diabetes are most at risk, support can be targeted where it’s most needed.”
