The peripheral atherosclerotic profile in patients with type 1 diabetes warrants a thorough vascular assessment of asymptomatic patients

Abstract

Aims Epidemiological data on subclinical atherosclerotic disease in type 1 diabetes mellitus (DM1) are scarce. We aimed to estimate the subclinical atherosclerosis profile of asymptomatic patients with DM1 and an abnormal ankle‐brachial index (ABI). Material and methods In a cross‐sectional design (http://ClinicalTrials.gov Identifier: NCT02910271), we estimated ABI in 289 consecutive asymptomatic patients with DM1. An abnormal ABI led to measurements of toe‐brachial index (TBI) and peripheral doppler ultrasound (DUS) to diagnose peripheral artery disease (PAD) and/or atherosclerotic carotid plaques (ACP). Results A reduced (≤0.9) or increased (>1.2) ABI was detected in 17 (6%) and 75 (26%) patients, respectively. PAD was confirmed by TBI and DUS in 9 (53%) patients with a reduced ABI and 28 (37%) patients with an increased ABI, resulting in a 12.8% (9.4‐17.2) prevalence of asymptomatic PAD. Fourteen patients with an abnormal ABI also exhibited ACP [4.8% (2.9‐7.9)], with 64% of these patients showing bilateral disease. Artery stenosis was mild or moderate in 21% and 29% of patients, respectively. Thus, 46 [16% (12‐21)] patients showed asymptomatic PAD, ACP, or both. According to our data, we would have to explore three asymptomatic patients with DM1 and normal pulses to unmask one case of PAD, and seven asymptomatic patients showing abnormal ABI values to detect one carotid disease. Conclusions Peripheral artery disease is often undiagnosed in asymptomatic patients with DM1. However, its presence may change medical management in a substantial percentage of cases, highlighting the potential benefit of a thorough vascular assessment on these patients.

High serum copeptin may be a marker of an increased carotid intima-media thickness in asymptomatic patients with type 1 diabetes

“…Exclusion criteria were: i) symptomatic intermittent claudication according to Edinburgh Claudication Questionnaire [8]; ii) previous diagnosis of peripheral artery disease, diabetic foot or leg amputation; iii) previous diagnosis of cerebrovascular disease iv) end-stage renal disease; and v) ongoing pregnancy. A detailed description of this trial has been reported elsewhere [7]. The study protocol conformed to the ethical guidelines of the Declaration of Helsinki, and was approved by Ramón y Cajal ethics committee (Date of approval: January 22, 2016; Reference number: 464/15).…”

High serum copeptin may be a marker of an increased carotid intima-media thickness in asymptomatic patients with type 1 diabetes.

“…We conducted an observational cross-sectional study including 60 asymptomatic T1DM-patients, from a larger cohort (clinicaltrials.gov Identi er: NCT02910271) designed to comprehensively address their subclinical atherosclerosis pro le [7]. T1DM required age at onset of diabetes <30 yr-old, previous episode of ketoacidosis or diabetic autoimmunity, and mandatory use of insulin for survival, as de ned by ADA criteria.…”

“…Exclusion criteria were: i) symptomatic intermittent claudication according to Edinburgh Claudication Questionnaire [8]; ii) previous diagnosis of peripheral artery disease, diabetic foot or leg amputation; iii) previous diagnosis of cerebrovascular disease iv) end-stage renal disease; and v) ongoing pregnancy. A detailed description of this trial has been reported elsewhere [7]. The study protocol conformed to the ethical guidelines of the Declaration of Helsinki, and was approved by Ramón y Cajal ethics committee (Date of approval: January 22, 2016; Reference number: 464/15).…”

“…A fasting blood sample and urine collection were collected to assess renal function and to measure the urinary albumin-to-creatinine ratio, serum lipids, and HbA 1c . Technical characteristics of assays used for biochemical measurements have been described elsewhere in detail [7].…”

“…A Toshiba Nemio model SSA-550A Basic Diagnostic Ultrasound System (Toshiba Medical System S.A., Alcobendas, Madrid, Spain) with a 7.5-MHz probe was used in these assessments. Common carotid, internal carotid, external carotid, and vertebral arteries were also scanned for the presence of carotid plaques (CP), de ned as IMT ≥ 1.5 mm protruding into the lumen [7].…”