Toe brachial index in middle aged patients with diabetes mellitus type 2: Not just a peripheral issue

Spångéus, Anna; Wijkman, Magnus; Lindström, Torbjörn; Engvall, Jan; Östgren, Carl Johan; Nyström, Fredrik; Länne, Toste

doi:10.1016/j.diabres.2013.03.004

Cited by 25 publications

(23 citation statements)

References 32 publications

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“…Age-matched participants from the CAREFUL (CArdiovascular REFerence popULation) study served as non-diabetic controls. As described previously [21], study participants in CAREFUL had been randomly selected from a population registry of individuals aged 50–70 years who resided within the catchment area of Linköping University Hospital. Individuals with previously known or newly discovered diabetes mellitus (defined as either a self-reported history of diabetes mellitus, current use of anti-diabetic medications or a fasting plasma glucose ≥ 7.0 mmol/l at base-line) were not eligible for participation in the CAREFUL study, and neither were individuals with a family history or known diagnosis of aortic aneurysm.…”

Section: Methodsmentioning

confidence: 99%

A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D3 and parathyroid hormone levels in patients with type 2 diabetes

Jennersjö

Guldbrand

Björne

et al. 2015

Diabetol Metab Syndr

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BackgroundLow levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes.MethodsThe main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the “Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care” study. Patients were 55–66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry.ResultsLevels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statistical significance (p >0.9).ConclusionsSerum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality that are independent of regular risk factors in addition to levels of ABP, IMT and PWV.Trial registrationClinicalTrials.gov: NCT01049737

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Section: Methodsmentioning

confidence: 99%

A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D3 and parathyroid hormone levels in patients with type 2 diabetes

Jennersjö

Guldbrand

Björne

et al. 2015

Diabetol Metab Syndr

Self Cite

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“…Furthermore, the effects of age and sex on TBI are almost unknown. 4,23) In this study, we clarified the characteristics of ABI, TBI, and PVR of healthy people in their early 20s together with baPWV using data measured from our medical students. We also discussed their ankle %MAP and UT, and the implications of these measurements.…”

Section: Introductionmentioning

confidence: 99%

Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

Watanabe

Hara

Yunoki

et al. 2015

Annals of Vascular Diseases

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Objective: To clarify the characteristics of ankle-brachial index (ABI), toe-brachial index (TBI), and pulse volume recording (PVR) of the ankle with brachial-ankle pulse wave velocity (baPWV) in healthy young adults. Material and Methods: We analyzed ABI, TBI, baPWV, and PVR in the ankle of healthy adults aged 20 to 25 years (median, 20 years) using an automatic oscillometric device between 2002 and 2013. The ABI, baPWV, and PVR in 1282 legs of 641 subjects (301 men and 340 women) and the TBI in 474 toes of 237 subjects (117 men and 120 women) were evaluated. Results:The measured values showed no bilateral differences. ABI and baPWV were higher in men than in women, but TBI was similar in both sexes. ABI <1.0 was observed in 18.1% of the legs in men and in 25.6% in women. TBI <0.7 was observed in 16.2% of the toes in men and 19.1% in women. For ankle PVR, the % mean arterial pressure was higher in women than in men. The upstroke time was <180 ms in most subjects. Conclusions: For young people, ABI <1.0 or TBI <0.7 may not always indicate vascular abnormalities. When evaluating circulatory indexes, age and sex should be considered.Keywords: ABI, TBI, baPWV, PVR, healthy young adults indications of ABI. The cut-off value of ABI for detecting PAD has been confirmed as 0.9 with high sensitivity and specificity. 2) Moreover, ABI is a strong predictor of cardiovascular events: the normal ABI range was revised as 1.00 to 1.40, because patients with ABI ranging from 0.91 to 0.99 have been shown to be at the borderline of cardiovascular risk. 2) On the other hand, TBI measurements are more cumbersome and are limited to special institutions (e.g., vascular laboratories) using different techniques including laser Doppler flowmetry, photoplethysmography, oscillometric plethysmography, and mercury strain gauge plethysmography. Thus, basic data on a uniform technique for a large population remain limited. Although the cut-off value of TBI for detecting PAD is set at 0.6 or 0.7, there has been no global consensus. 1,[3][4][5] Although the normal standard ranges of ABI and TBI are based on data obtained mostly from middle and senior adults, [3][4][5][6] young patients with lower limb complaints such as coldness, pain, or claudication are also primarily examined by ABI and TBI measurements because PAD including Buerger disease, Raynaud disease, Takayasu arteritis, and even arteriosclerotic diseases can occur in young patients, as the prevalence of PAD is estimated to be 1.2% to 4% of people in their late 20s. 7) However, they occasionally show ABI <1.0 or TBI <0.7 despite their normal physical findings, making the diagnosis confusing.The gold standard method for ABI measurement has been the Doppler method since the 1980s, 2) but on the other hand, automated oscillometric sphygmomanometers have come into use recently. Moreover, full-automated ABI/TBI measuring devices have been developed since the late 1990s. 8,9) We have used the automated ABI/TBI measuring devices in our clinical work. The form PWV/ABI ® (Colin Co., Aichi, Jap...

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“…The ABPI is the ratio of the systolic blood pressure measured at the ankle to that measured at the brachial artery [14]. However, the ABPI may not always be reliable, particularly in patients with diabetes where vascular calcification can prevent arterial compression and falsely increase arterial systolic pressure and therefore the ABPI [15]. The ABPI may thus be confounded in diabetic patients, because of calcification of the arteries.…”

Section: Diagnosis Of Ulcer Cruris In the Zgtmentioning

confidence: 99%

Evaluation of the introduction of the one stop clinic and dedicated nurses for the ulcer cruris venosum care in the east of the Netherlands

Kroft¹,

Rook²,

Wikkerink³

2018

J Phlebol Lympho

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Toe brachial index in middle aged patients with diabetes mellitus type 2: Not just a peripheral issue

Cited by 25 publications

References 32 publications

A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D3 and parathyroid hormone levels in patients with type 2 diabetes

A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D3 and parathyroid hormone levels in patients with type 2 diabetes

Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

Evaluation of the introduction of the one stop clinic and dedicated nurses for the ulcer cruris venosum care in the east of the Netherlands

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