Social deprivation — lacking social connections and interaction — was linked to a higher risk of foot complications in people with type 2 diabetes in a new study published in the journal Diabetes Care.
It has long been known that social deprivation can lead to a wide range of poor health outcomes, even ones that don’t seem related to a person’s social life. For this study, researchers were interested in how, if at all, social deprivation affected the eventual development of foot complications in people with newly diagnosed diabetes. The study’s participants were 150,265 people, with an average age of 62.9 at the time of their diagnosis, who were also found not to have diabetic foot disease at that time or within 15 months after their diagnosis.
During an average follow-up period of 3.27 years, 12.1% of the participants developed diabetic foot disease. Based on their answers to a questionnaire designed to assessed social deprivation, participants were grouped into five categories — with the same number of participants in each group — based on being less or more socially deprived. The researchers then examined the connection between social deprivation and developing foot complications after adjusting for a number of other factors that could affect a person’s foot disease risk — including sex, age at the time of diabetes diagnosis, ethnicity, smoking, body-mass index (BMI, a measure of body weight that takes height into account), A1C level (a measure of long-term blood glucose control), cardiovascular disease, hypertension (high blood pressure), retinopathy (eye disease), kidney function and estimated risk for foot problems at the time of diabetes diagnosis.
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Social deprivation linked to foot disease risk
The researchers found that even after controlling for all of these factors, greater social deprivation was linked to a higher risk of diabetic foot disease. Compared with the least socially deprived group, those with the greatest social deprivation were 22% more likely to develop foot complications during the study period. When it came to specific issues, participants with the greatest social deprivation were 18% more likely to develop peripheral neuropathy, 44% more likely to develop a foot ulcer, 40% more likely to develop peripheral vascular disease, 75% more likely to have a lower limb amputation, and a whopping 749% more likely to develop gangrene than participants with the least social deprivation.
The researchers concluded that social deprivation is an independent risk factor for diabetic foot disease, with some specific conditions tied more closely to it than others. “Considering the high individual and economic burdens” of foot complications, the researchers wrote, “strategies targeting patients in socially deprived areas are needed to reduce health inequalities.”
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