Abstract
Introduction: Individuals with peripheral artery disease (PAD) often experience reduced physical function and activity, which may increase the future risk of diabetes. Although diabetes is a risk factor of PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Hypothesis: Low ABI is independently associated with increased risk of incident diabetes. Methods: ABI was measured on a randomly selected leg in 12,244 black and white participants without prevalent diabetes at baseline (1987-1989). Incident diabetes cases were identified by glucose measurements (fasting ≥126 mg/dl or non-fasting ≥200 mg/dl) at subsequent three visits (1990-92, 1993-95, and 1996-98) and self-reported diagnosis or medication use at those visits or during annual phone interview through 2011. We examined the association of ABI with incident diabetes after accounting for potential confounders using Cox proportional hazards models. Results: A total of 3304 participants developed diabetes during a median of 21 years of follow-up. Participants with low (<=0.9) or borderline low (0.9-1.0) ABI had 30-40% higher risk of future diabetes as compared to those with ABI of 1.1-1.2 in the demographically adjusted model (Table 1). The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.9-1.0 (HR=1.17, 95%CI 1.04-1.31), even after accounting for fasting glucose at baseline (P=0.046). The association were also attenuated for ABI <=0.9 (HR=1.19 [95% CI 1.00-1.43]) and remained borderline significant in model adjusting for confounders except fasting glucose. The association of low ABI with diabetes was more evident in persons with normal glucose (fasting glucose <100 mg/dl) than in those with impaired fasting glucose (100-125 mg/dl). Conclusions: Low ABI was mildly but independently associated with increased risk of incident diabetes in the general population. Attentions are needed regarding diabetes risk and glucose trajectory among people with low ABI.
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