Abstract 407: The Association Between Diabetic Peripheral Neuropathy and Peripheral Artery Disease

Abstract

Diabetic peripheral neuropathy (DPN) and peripheralartery disease (PAD) are common complications that occur more frequently in patients with type 2 diabetes than in the general population. Data on the association between these conditions is surprisingly scant. We searched the electronic medical records of 37,095 members of Kaiser Permanente Northwest who had type 2 diabetes identified prior to 2013 and had complete health plan eligibility in 2012 for physician-coded ICD-9-CM diagnoses of DPN or PAD in 2010-2012. We compared demographic (age, sex, diabetes duration) and clinical characteristics (BMI, HbA 1c , blood pressure, lipids, and presence of ischemic heart disease [IHD], chronic kidney disease [CKD] and heart failure [HF]) associated with the presence of one or both of these conditions. To isolate the independent association between DPN and PAD, we constructed a multiple logistic regression model that controlled for risk factors for DPN and PAD. Of the 37,095 type 2 diabetes patients, 29% (n=10,636) had DPN and 7% (n=2,586) had PAD. Among patients with DPN, 15% had PAD compared with 4% without DPN (p<0.001). Nearly two-thirds of patients with PAD also had DPN, while about one-quarter of patients without PAD had DPN (62% vs. 26%, p<0.001). Characteristics of patients without PAD differed markedly depending on whether DPN was present. For example, mean age of patients with DPN but no PAD was 67.3 years, compare with 59.9 years among those without DPN or PAD (p<0.001), and those with DPN were two to three times more likely to have IHD, CKD or HF. Conversely, characteristics including age, sex and presence of comorbidities were similar among patients with PAD regardless of the presence of DPN. After controlling for the aforementioned common risk factors, presence of DPN more than doubled the probability of having PAD (OR 2.32, 95% CI 2.08-2.60). Our results demonstrate a strong association between DPN and PAD that remained even after controlling for a number of characteristics. Although our design did not evaluate the temporal relationship between these two conditions, older age and longer duration of diabetes among PAD patients suggests that DPN may often precede PAD. Research is needed to determine whether treating DPN can reduce the risk of PAD.