Outcomes following Lower Extremity Amputation in Patients with Diabetes Mellitus and Peripheral Arterial Disease

Pourghaderi, Poya; Yuquimpo, Kyle; Guetter, Camila Roginski; Mansfield, Lauren; Park, Henry S.

doi:10.1016/j.avsg.2019.08.084

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…LEAD is the manifestation of peripheral atherosclerotic disease and is characterized as the stenosis and occlusion of lower limb arteries [25]. Due to the similar pathophysiological mechanisms (such as oxidative stress and endothelial dysfunction) between LEAD and atherosclerosis in other vasculature, LEAD is closely related to the occurrence of cardiovascular disease [11,12,26]. In addition, diabetes-associated LEAD is often concomitant with neuropathy [27].…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremity atherosclerotic disease (LEAD) is one of the major vascular complications of diabetes and is associated with a substantial increase in the risk of nonfatal (such as gangrene, amputation, etc.) and fatal cardio-and cerebrovascular events [11,12]. Furthermore, diabetes was observed to be independently associated with an increased risk of LEAD, depending on the severity of cardiovascular diseases [13].…”

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confidence: 99%

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The association between serum growth differentiation factor 15 levels and lower extremity atherosclerotic disease is independent of body mass index in type 2 diabetes

et al. 2020

Cardiovasc Diabetol

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Background: Clinical and basic investigations have indicated a significant association between circulating growth differentiation factor 15 (GDF15) and cardiovascular disease; however, the relationship between GDF15 and lower extremity atherosclerotic disease (LEAD) has been less studied. The present study aimed to explore the association between GDF15 and LEAD in Chinese patients with type 2 diabetes mellitus (T2DM). Considering that obesity is an important factor associated with circulating GDF15 levels, whether the relationship between serum GDF15 levels and LEAD is affected by body mass index (BMI) was also analysed.Methods: A total of 376 hospitalized T2DM patients were enrolled (161 with LEAD and 215 without LEAD). A sandwich enzyme-linked immunosorbent assay was used to detect the serum GDF15 levels. The femoral intima-media thickness (F-IMT) and LEAD were assessed by ultrasonography.Results: Patients with LEAD had significantly higher serum GDF15 levels than those without LEAD, regardless of whether their BMI was < 25 kg/m 2 or ≥ 25 kg/m 2 (both P < 0.05). Serum GDF15 levels were independently positively related to the F-IMT (standardized β = 0.162, P = 0.002). After adjusting for confounding factors, per 1-standard deviation (SD) increase in the serum GDF15 levels was significantly related to an approximately 1.4-fold increased risk of LEAD in the total population (P < 0.05). Regardless of whether the BMI was < 25 kg/m 2 or ≥ 25 kg/m 2 , this association remained significant, with approximately 1.6-and 1.4-fold increased risks of LEAD, respectively (both P < 0.05). Conclusions: High serum GDF15 levels were significantly correlated with an increased risk of LEAD in T2DM patients, and this relationship was independent of BMI.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The association between serum growth differentiation factor 15 levels and lower extremity atherosclerotic disease is independent of body mass index in type 2 diabetes

et al. 2020

Cardiovasc Diabetol

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“…Lower extremity atherosclerotic disease (LEAD) is one of the life-threatening complications of diabetes. LEAD and the subsequent vascular occlusion, gangrene and lower extremity amputation seriously affect the quality of life of patients and increase the economic burden [ 1 , 2 ]. However, the onset of LEAD is insidious, and 40% of patients are asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

Visit-to-visit variability of glycated albumin was associated with incidence or progression of lower extremity atherosclerotic disease

Shen

Dai

et al. 2020

Cardiovasc Diabetol

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Background The aim of this study was to investigate the association of visit-to-visit variability of hemoglobin A1c (HbA1c) and glycated albumin (GA) with the risk of lower extremity atherosclerotic disease (LEAD). Method We performed a prospective cohort study of 436 patients with type 2 diabetes (258 men and 178 women) with at least 3 measurements of HbA1c and GA prior to baseline investigation from the Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital. Different HbA1c and GA variability markers were calculated. Multivariable Cox proportional hazard regression models were used to demonstrate the association between visit-to-visit HbA1c and GA variability and the risk of incident or progressive LEAD. Results During a mean follow-up period of 3.77 years, 112 participants developed LEAD. Multivariate-adjusted hazard ratios (HRs) of LEAD across tertiles of GA-CV values were 1.00, 1.06 (95% confidence interval [CI] 0.65–1.75), and 1.71 (95% CI 1.07–2.73) (P for trend = 0.042), respectively. When we used GA-VIM and GA-ARV values as exposures, similar positive associations with the risk of LEAD primary were found. Multivariate-adjusted HRs of LEAD for each 1 unit increase in GA-CV, GA-VIM and GA-ARV were 1.03 (95% CI 1.01–1.06), 1.32 (95% CI 1.03–1.69), and 1.07 (95%CI 1.01–1.15), respectively. However, there was no significant association between visit-to-visit variability of HbA1c and the risk of LEAD. Conclusions Visit-to-visit variability of GA may be an optimal biomarker in relation to LEAD risk among patients with type 2 diabetes.

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“…The EXSCEL study demonstrated that patients with DM and PAD had higher rates of all-cause death, lower-extremity amputation and target limb revascularization compared to patients without PAD, over a median follow up of 3.2 years [25]. Moreover, a large retrospective study including almost 62,300 patients from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, showed that patients with coexistent PAD and DM had higher prevalence of lower-extremity amputation (47%) compared to patients with either DM alone (26%) or PAD alone (26%), indicating that DM and PAD have an additive effect on overall risk [26].…”

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confidence: 99%

Diabetes mellitus: an important risk factor for peripheral vascular disease

Giannopoulos

Armstrong

2020

Expert Review of Cardiovascular Therapy

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Outcomes following Lower Extremity Amputation in Patients with Diabetes Mellitus and Peripheral Arterial Disease

Cited by 14 publications

References 21 publications

The association between serum growth differentiation factor 15 levels and lower extremity atherosclerotic disease is independent of body mass index in type 2 diabetes

The association between serum growth differentiation factor 15 levels and lower extremity atherosclerotic disease is independent of body mass index in type 2 diabetes

Visit-to-visit variability of glycated albumin was associated with incidence or progression of lower extremity atherosclerotic disease

Diabetes mellitus: an important risk factor for peripheral vascular disease

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