Diabetes mellitus and outcomes of lower extremity revascularization for peripheral artery disease

Abstract

Aims The impact of diabetes mellitus (DM) on outcomes of lower extremity revascularization (LER) for peripheral artery disease (PAD) is uncertain. We characterized associations between DM and post-procedural outcomes in PAD patients undergoing LER. Methods and results Adults undergoing surgical or endovascular LER were identified from the 2014 Nationwide Readmissions Database. DM was defined by ICD-9 diagnosis codes and sub-classified based on the presence or absence of complications (poor glycaemic control or end-organ damage). Major adverse cardiovascular and limb events (MACLEs) were defined as the composite of death, myocardial infarction, ischaemic stroke, or major limb amputation during the index hospitalization for LER. For survivors, all-cause 6-month hospital readmission was determined. Among 39 441 patients with PAD hospitalized for LER, 50.8% had DM. The composite of MACLE after LER was not different in patients with and without DM after covariate adjustment, but patients with DM were more likely to require major limb amputation [5.5% vs. 3.2%, P < 0.001; adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.03–1.44] and hospital readmission (59.2% vs. 41.3%, P < 0.001; aOR 1.44, 95% CI 1.34–1.55). Of 20 039 patients with DM hospitalized for LER, 55.7% had DM with complications. These patients were more likely to have MACLE after LER (11.1% vs. 5.2%, P < 0.001; aOR 1.56 95% CI 1.28–1.89) and require hospital readmission (61.1% vs. 47.2%, P < 0.001; aOR 1.41 95% CI 1.27–1.57) than patients with uncomplicated DM. Conclusions DM is present in ≈50% of patients undergoing LER for PAD and is an independent risk factor for major limb amputation and 6-month hospital readmission.

Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review

“…This concomitant peripheral neuropathy may predispose patients with T2DM and PAD to present with advanced disease compared to patients without diabetes [ 2 , 55 ]. Hence, those with T2DM and PAD are more likely to develop chronic limb-threatening ischemia (CLTI) [ 5 , 11 , 56 ]. The coexistence of diabetes mellitus with peripheral neuropathy and PAD may also make the presentation of foot infection more subtle [ 11 ].…”

“…Patients with concomitant T2DM and PAD are at a high risk of cardiovascular events, including lower-limb events [ 2 , 4 ]. Moreover, patients with PAD and T2DM are 2–10× more likely than non-diabetic patients to undergo an amputation [ 2 , 5 ]. Indeed, approximately 70% of cases undergoing lower-extremity amputation in the United States are attributed to diabetes [ 6 ].…”