The Course of Peripheral Vascular Disease in Non-insulin-dependent Diabetes

Abstract

The present report is an analysis of the course of peripheral vascular disease (PVD) in 619 patients with non-insulin-dependent diabetes (NIDDM) recruited within 1 yr of diagnosis and followed quarterly for up to 14 yr (X = 10.5 yr). At 13 yr duration, the actuarially determined cumulative risks for intermittent claudication (IC), nonpalpable dorsalis pedis pulse (NPUL), and arterial calcification (CALC) were, respectively, 37.9%, 34.5%, and 60.9% for men and 24.3%, 37.6%, and 32.2% for women. Major amputations (AMP) occurred in only 1.3% of the patients, equivalent to approximately one case per 1000 patients per year. The corresponding incidences of IC, NPUL, and CALC were, respectively, 29, 27, and 47 per 1000 men and 19, 27, and 25 per 1000 women per year. CALC and NPUL were strongly related to mortality. Baseline risk factors with probability levels that suggest a relationship to PVD were, in women, age versus CALC (P less than 0.01), age versus NPUL (P less than 0.05), weight versus NPUL (P less than 0.05), systolic BP versus CALC (P less than 0.01), summed glucose tolerance test versus CALC (P less than 0.01), and triglyceride level versus CALC (P less than 0.05). In men, the only significant risk factors were diminished vibration perception, which was related to NPUL (P less than 0.05), and the serum triglyceride level, which was related to IC (P less than 0.05). In patients who are carefully followed prospectively, IC is far more common, but AMP is far less common than has been generally appreciated. Further studies are needed to clarify the roles of the diverse risk factors that are possibly related.

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

“…In the present study, factors like age, sex and duration of diabetes did not have such an evident influence on the outcome compared with other studies [21,22,[25][26][27]. Age is known to be an important factor related to progress of PVD, neuropathy and lower leg amputation [3,28,29] as well as to probability of healing, [9], but this was not the case in all studies [21] and especially not in short-term observation studies of neuropathic foot ulcer <20 weeks [22,26]. In the present study 51% of patients older than 80 years of age healed without any amputation.…”

UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes

“…In prospective studies, fasting blood glucose was not associated with claudication (19), and chronic hyperglycemia was not associated with peripheral arterial disease (20). In the University Group Diabetes Program, hyperglycemia following oral glucose was not associated with claudication or an absent DP pulse (21). The true association between hyperglycemia and PVD is possibly stronger than that observed in this study, given that this report is based on a measure of HbA 1c shortly after diagnosis of diabetes, because hyperglycemia is a risk factor for death, and because this study did not take into account glucose-lowering treatments.…”

Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing

“…Several investigators have found that PAD progresses over time. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][35][36][37] Dormandy et al state that there is general agreement that only about 25% of PAD patients will significantly deteriorate symptomatically over time, but that the underlying atheromatous disease almost certainly progresses. 1 Categorical progression of PAD severity has been demonstrated in a few studies, 7,14,17,18 with the estimates ranging between a low of 2.5% per year developing rest pain or gangrene reported by Jelnes et al, 7 and a high of 9.1% per year showing angiographic evidence of pro- 17 In the present study, approximately 3.7% of the patients' limbs per year demonstrated categorical progression (16.9% over 4.6 years of follow-up), providing an estimate comparable with previous studies.…”

“…The majority of such studies have dealt with surrogate measures of disease severity such as changes in intermittent claudication, the development of gangrene or ulceration, or the requirement for angioplasty, vascular reconstruction or amputation. [1][2][3][4][5][6][7][8][9][10][11][12] A small number of studies have looked at the progression of PAD via serial angiographic measurements of lesion severity or a combination of angiography, non-invasive testing and surrogate endpoints. [13][14][15][16][17] Two studies have analyzed PAD progression in selected patients using serial measurement views and clinical evaluation.…”