Decline in ankle-brachial index is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall cohort study

Kowall, Bernd; Erbel, Raimund; Moebus, Susanne; Lehmann, Nils; Kröger, Knut; Stang, Andreas

doi:10.1016/j.atherosclerosis.2019.02.021

Cited by 7 publications

(5 citation statements)

References 40 publications

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“… 36 Other researchers found that patients with HbA1c levels 7%, or higher, had a greater decline on ABI in a 10-year follow up; expecting a lower survival time for PAD in patients with bad glycemic control. 37 Our study found the opposite, but the mean difference between groups showed a higher HbA1c for PAD group. Therefore, it is not clear whether bad glycemic control diminishes survival time for PAD, although the previously mentioned evidence tends to support this fact.…”

Section: Discussioncontrasting

confidence: 57%

“…Therefore, it is not clear whether bad glycemic control diminishes survival time for PAD, although the previously mentioned evidence tends to support this fact. 37 There are few investigations trying to assess the influence of different variables in the probability of developing PAD. A multivariate regression model in a Spanish DM population found an association of PAD with age and the presence of retinopathy.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care

Barrera-Guarderas

Carrasco-Tenezaca

Torre-Cisneros

2020

J Prim Care Community Health

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Background Peripheral artery disease (PAD) is associated with cardiovascular risk in type 2 diabetes mellitus (DM). The ankle-brachial index (ABI) is used for diagnosis of PAD. Objectives Establish the prevalence and incidence rate for PAD and determine the associated factors and survival time for the development of PAD. Methods Retrospective cross-sectional cohort study (follow up: 10 years) in 578 DM patients with at least 1 ABI measurement in a primary level of care diabetes clinic. Data was collected from clinical records. Sociodemographic and laboratory variables were analyzed determining its association (mean difference and bivariate logistic regression). Survival was calculated through life tables and Kaplan-Meier analysis. Results The prevalence of PAD was 13.98%. The incidence rate through the time of follow up was 23.38 per 1000 person-year (95% CI: 19.91-27.26). The group that developed PAD showed higher glycated hemoglobin levels ( P = .025), more years of DM ( P < .001) and lower glomerular filtration rate (GFR, P = .003). The median time for developing PAD was 26.97 years (95% CI: 26.89-27.05). The risk for PAD was higher in females (95% CI: 1.51-4.38), GFR <60 mL/min/m2 (95% CI: 1.05-2.22) and use of metformin plus insulin (95% CI: 1.10-2.35). Conclusion Half of a DM patient’s population in primary level of care will develop PAD in the third decade of disease. There are identifiable risk factors for PAD development in DM in the primary level of care such as low GFR, female sex, and use of metformin plus insulin.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care

Barrera-Guarderas

Carrasco-Tenezaca

Torre-Cisneros

2020

J Prim Care Community Health

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“…The progression of atherosclerosis in the carotid and coronary arteries is aggravated by hyperglycemia [ 42 ]. In addition, the decline in ABI is more substantial in poorly controlled patients with diabetes [ 43 ]. Subclinical atherosclerosis and plaque in carotid and coronary arteries are more common in diabetes and prediabetes, and over 50% of asymptomatic T2DM have subclinical atherosclerosis [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Ankle Brachial Index and Carotid Artery Stenosis in Patients with Type 2 Diabetes

Đermanović Dobrota,

Brkljačić,

Tičinović Ivančić

et al. 2024

Metabolites

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Type 2 diabetes mellitus (T2DM) significantly increases the risk of atherosclerotic cardiovascular disease. Ankle brachial index (ABI) and carotid artery stenosis are non-invasive indicators of generalized atherosclerosis. This study aimed to explore the risk factors for ABI and carotid artery stenosis and discover which factors simultaneously influence both conditions in T2DM. The study included a total of 101 patients with T2DM. ABI was performed via Doppler ultrasound, and both common carotid arteries were examined via ultrasound to obtain the percentage of carotid artery stenosis. A negative correlation was noted between the ABI and the percentage of carotid artery stenosis (p = 0.043). ABI correlated significantly negatively with waist circumference (p = 0.031), total cholesterol (p = 0.003), low-density lipoprotein (LDL) cholesterol (p = 0.003), and C-reactive protein (CRP) (p = 0.017), whereas the percentage of carotid artery stenosis correlated with the smoking habit (p = 0.017) and CRP (p = 0.042). The best model for predicting the ABI value (R2 = 0.195) obtained from stepwise regression analysis included waist circumference, LDL cholesterol, triglycerides, and CRP, while the best model for the percentage of the carotid artery stenosis (R2 = 0.112) included smoking and CRP. CRP influenced the ABI value with a negative parameter estimate of −0.008962 (p = 0.053) and the percentage of the carotid artery stenosis with a positive parameter estimate of 0.443655 (p = 0.006) relative to a one-unit change of it, presenting the negatively significant impact of CRP on the association between carotid artery stenosis and low ABI. Our results suggest that CRP is the most important risk factor that connects ABI and carotid artery stenosis, which are important non-invasive indicators of generalized atherosclerosis in T2DM.

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“…We suggest that TIR may be a more valuable clinical indicator than HbA1C in indicating ABI abnormalities, but further studies are needed to confirm this conclusion. One possible explanation is that HbA1C is primarily associated with microvascular diseases, while ABI is primarily associated with macrovascular complications such as myocardial infarction, stroke, or PAD [44]. On the other hand, HbA1C cannot accurately reflect hypoglycemia and blood sugar fluctuations, which may also be risk factors for diabetic vascular diseases [45][46][47].…”

Section: Discussionmentioning

confidence: 99%

The association between time in the glucose target range and abnormal ankle-brachial index: a cross-sectional analysis

Wei

Liu

et al. 2022

Cardiovasc Diabetol

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Background Time in range (TIR), a novel proxy measure of glucose control, is found closely related to diabetic microangiopathy and some other chronic complications, but the correlation between TIR and lower limb angiopathy has not been studied yet. Our purpose is to explore the relationship between TIR and abnormal ankle-brachial index(ABI) in type 2 diabetes. Methods We retrospectively collected patients’ information from the database and performed cross-sectional analysis. A total of 405 type 2 diabetes patients were enrolled in this study. ABI was measured and patients were stratified into low, normal, and high groups according to ≤ 0.9, > 0.9 and < 1.3, ≥ 1.3 ABI values. All patients underwent continuous glucose monitoring(CGM), and TIR was defined as the percentage of time in which glucose was in the range of 3.9–10 mmol/L during a 24-h period. Correlations between TIR and abnormal ABI were analyzed using Spearman analysis. And logistic regression was used to explore whether TIR is an independent risk factor for abnormal ABI. Results The overall prevalence of abnormal ABI was 20.2% (low 4.9% and high 15.3%). TIR was lower in patients with abnormal ABI values (P = 0.009). The prevalence of abnormal ABI decreased with increasing quartiles of TIR (P = 0.026). Abnormal ABI was negatively correlated with TIR and positively correlated with hypertension, age, diabetes duration, UREA, Scr, ACR, TAR, MBG, and M values (P < 0.05). The logistic regression revealed a significant association between TIR and abnormal ABI, while HbA1C and blood glucose variability measures had no explicit correlation with abnormal ABI. Additionally, there was a significant difference in LDL between the low and high ABI groups (P = 0.009), and in Scr between normal and low groups (P = 0.007). And there were significant differences in TIR (P = 0.003), age (P = 0.023), UREA (P = 0.006), ACR (P = 0.004), TAR (P = 0.015), and MBG (P = 0.014) between normal and high ABI groups, and in diabetes duration between both normal and low (P = 0.023) and normal and high (P = 0.006) groups. Conclusions In type 2 diabetes patients, abnormal ABI is associated with lower TIR, and the correlation is stronger than that with HbA1C. Therefore, the role of TIR should be emphasized in the evaluation of lower limb vascular diseases.

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Decline in ankle-brachial index is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall cohort study

Cited by 7 publications

References 40 publications

Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care

Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care

Risk Factors for Ankle Brachial Index and Carotid Artery Stenosis in Patients with Type 2 Diabetes

The association between time in the glucose target range and abnormal ankle-brachial index: a cross-sectional analysis

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