Abstract
Little is known about the relationship between lower extremity peripheral arterial disease (PAD) and proliferative diabetic retinopathy (PDR) in type 2 diabetes (T2D). Here, we explored the relationship between sight-threatening PDR and PAD. We screened for diabetic retinopathy (DR) and PAD in hospitalized patients with T2D. Patients with a diabetic duration of more than 10 years, HbA1c ≥7.5%, eGFR ≥60mL/min/1.73m2 and with PDR or with no diabetic retinopathy (NDR) were eligible for this cross-sectional study. Severities of DR were graded by digital retinal photographs according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. We assessed PAD by measuring Ankle Brachial Index (ABI), Toe Brachial Index (TBI) and Doppler ultrasound. Statistical analyses were performed using SPSS 17.0 software. Of the 1544 patients, 169 patients with extreme eye (57 PDR and 112 NDR) phenotypes met the inclusion criteria. Patients with PDR had a significantly higher proportion of low ABI (≤0.99) and high ABI (≥1.3) than patients with NDR (28.1% and 15.8% vs. 14.3% and 6.2% respectively, P<0.05). PDR patients also had lower TBI than NDR patients (0.56±0.09 vs. 0.61±0.08, P<0.01). The proportion of patients with abnormal duplex ultrasound was higher in PDR than in NDR (21.1% vs. 9.8%, P<0.001). This showed that PDR associated with PAD could be defined in multiple ways: abnormal ABI (≤0.9) (OR = 3.61, 95% CI: 1.15–11.26), abnormal TBI (OR = 2.84, 95% CI: 1.19–6.64), abnormal duplex (OR = 3.28, 95% CI: 1.00–10.71), and critical limb ischemia (OR = 5.52, 95% CI: 2.14–14.26). Moreover, PDR was a stronger independent correlation factor for PAD than a diabetic duration of 10 years. In conclusion, PAD is more common in PDR than in NDR. It implies that PDR and PAD are mostly concomitant in T2D. We should focus on screening PAD in patients with PDR in clinical practice.
Highlights
Type 2 Diabetes (T2D) often entails micro- and macrovasclar complications
Patients in the proliferative diabetic retinopathy (PDR) and no diabetic retinopathy (NDR) groups showed no significant differences in gender, body mass index (BMI), systolic blood pressure (SBP), duration of diabetes, history of smoking, hypertension, CHD or biochemical parameters (HbA1c, FBG, total cholesterol (TC), TG, LDL, HDL, and estimated glomerular filtration rate (eGFR))
There were no significant differences in gender, BMI, SBP, duration of diabetes, history of smoking, hypertension, CHD or biochemical parameters (HbA1c, FBG, TC, TG, LDL, HDL, and eGFR) between the PDR and NDR groups
Summary
Peripheral arterial disease (PAD) is characterized by reduced blood flow to the lower extremities, which may require amputation, and has been associated with increased risk of coronary artery disease or stroke. Diagnosis of PAD may allow for earlier treatment, which could help to prevent or postpone complications associated with PAD. T2D patients with PAD are at increased risk of morbidity and mortality from cardiovascular diseases. PAD is an important risk factor of diabetic foot, and is one of the major reasons for amputation [1, 2]. It is an urgent task know how to find PAD at an early stage
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