Pulse Pressure and Prediction of Incident Foot Ulcers in Type 2 Diabetes

Abstract

OBJECTIVE -To assess the relevance of pulse pressure as a predictor of foot ulcers in type 2 diabetic subjects.RESEARCH DESIGN AND METHODS -A cohort study was performed on a consecutive series of 1,945 type 2 diabetic outpatients without a foot ulcer at baseline. Incident foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses.RESULTS -During a follow-up of mean Ϯ SD 4.2 Ϯ 2.2 years, 86 ulcers were observed. After adjusting for confounders, the highest quartiles of pulse pressure had a 2.39-fold (95% CI 1.14 -5.02) risk of foot ulcers. When ischemic ulcers were considered separately, the highest pulse pressure quartile was associated with an increased age-and sex-adjusted risk (2.08 [95% CI 1.02-4.24]), whereas no increase of risk was observed for neuropathic ulcers.CONCLUSIONS -Elevated pulse pressure represents an independent predictor of foot ulcers in diabetic patients; this parameter should be considered for the stratification of risk of ischemic or neuroischemic ulcers.

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

“…Our exploration of missing data found the pattern of 'missingness' to be MAR. 74,75 to 71 years in the study by Crawford et al 5 Figure 3 shows the similar distribution of age per study, with higher modes for the more recent studies by Monami 72 and Crawford. 5 The overall percentage of men was 58% and varied from 44% to 57% for most studies, but was 98% in the study by Boyko et al 49 Average weight and height were recorded for only four studies, with BMI recorded more commonly.…”

“…3,5,61,62,[72][73][74][75] Data from a ninth study 46,47 were made available to the Data Management Committee via Safe Haven, a data-management system. Finally, a 10th corresponding author was not granted permission to share the data from a cohort study by the Institutional Review Board 48 but was able to contribute to the meta-analysis by subjecting the data to the same analytical procedures as all other studies to provide estimates of effect, which could be incorporated into the final (meta) analysis.…”

“…Follow-up occurred, on average, 4.2 ± 2.2 years, and ascertainment of the outcome variable was achieved by accessing routinely collected data. 72 Two hundred and forty-eight people with diabetes were recruited from one of three large diabetic foot centres in the USA between January 1995 and January 1996. The diagnosis of diabetes mellitus was confirmed by a primary care provider or from medical records.…”

“…For a total of 2536 patients from two studies, 72,75 the variables required to assess sensory loss were not available. For a total of 12,360 diabetic patients from seven studies, the necessary variables were available at baseline to allocate their risk categories.…”

Pulse pressure and michigan neuropathy screening instrument are independently associated with asymptomatic peripheral arterial disease among type 2 diabetes community residents: A community-based screening program in Taiwan

“…[20] Several studies have found an association of high pulse pressure with large artery stiffness, [21] higher mortality (overall, cardiovascular and cerebrovascular diseases) [22][23][24][25] and higher risks of foot ulcers. [26] However, most of these studies have been targeted at the general diabetic population. In our study, the level of pulse pressure contributed independently as a risk factor (OR: 1.032 for every 1-mmHg increment; 95% CI: 1.012-1.053, p = 0.002) for asymptomatic PAD in type 2 diabetic adults.…”