Diabetic foot ulcers are more severe among men than women when patients are first seen, even when members of both sexes present for care at the same length of time after onset. Females also have a higher probability of ulcer healing and less amputation.

That’s according to a study of nearly 1,800 Belgian wound clinic patients, but the findings have implications for all who care for patients with diabetes. Researchers suggest attention to sex should be used to optimize preventive and therapeutic strategies.

Researchers pointed to a worse vascular state associated with men’s higher rate of previous or current smoking as one potential contributor. Men in the study also more frequently presented with more severe symptoms of peripheral artery disease, including critical limb ischemia.

Overall, ulcers in men were deeper, more frequently open to the bone, and more frequently “deeply infected.” Twice as many men presented with systemic infection as women. Men demonstrated a higher prevalence of previous lower limb revascularization, while women presented more frequently with renal insufficiency. The full study was published in PLOS One in February. n