Peripheral Arterial Disease In Type Research Articles

Toe brachial index and not ankle brachial index is appropriate in initial evaluation of peripheral arterial disease in type 2 diabetes.

Non-invasive clinic-based tools for assessing PAD are not without limitations. Therefore, costly tests like Doppler study, CT angiography and MR angiography are often required to make a diagnosis. Ankle brachial index (ABI), commonly used for assessment of PAD,hashigh false positivity rates in sclerosed, calcified arteries which render them non-compressible. Toe brachial index (TBI) can be an alternative, as digital arteries are relatively unaffected by these changes. To compare the reliability of ABI and TBI in diagnosing PADin type 2 diabetes using CT angiography (CTA) as the reference. 175 adults with T2D were selected. ABI &TBI were measured with an automated vascular Doppler XT 6 ports bilaterally for all subjects. For any subject, the limb with lower ABI and TBI was included for analysis. ABI < 0.9 & TBI < 0.6 were taken as evidence of PAD. CTA showing > 50% narrowing was taken as evidence of PAD. 24% of our study subjects had CTA confirmed PAD. ABI has low sensitivity of 35.29% (95% CI 0.21-0.52) compared to TBI being 82.35% (95% CI 0.66-0.92). The specificity however was similar. ABI < 0.9 was able to detect CTA confirmed PAD, but ABI > 0.9, including the so-called normal ABI (0.9-1.3) was unable to detect PAD. ROC showed ABI at 1.005 has sensitivity 64.71% (95% CI 0.48- 0.79) and specificity 61.7% (95% CI 0.53-0.69) and TBI at 0.6 has sensitivity 82.35% (95% CI 0.66-0.92) & specificity 92% (95% CI 0.87-0.96). Utilizing Cohen's Kappa, the reliability of ABI with respect to CTA showed fair agreement (K = 0.225, p = 0.001), whereas the reliability of TBI with respect to CTA showed substantial agreement (K = 0.759, p < 0.0001). ABI < 0.9 detects PAD reliably, but presence of PAD in patients with ABI > 9.0 including the normal of ABI (0.9-1.3) can be confirmed with TBI, which correlated strongly with CTA. TBI is also non-inferior for PAD detection, when ABI < 0.9. TBI and not ABI can be utilized for initialassessment of PAD in subjects with T2D.

A comparative study of cardiovascular risk stratification methods in type 1 diabetes mellitus patients

The Steno Diabetes Center Copenhagen developed the Steno T1 Risk Engine (ST1RE) to predict cardiovascular events, encompassing fatal and nonfatal ischemic heart disease, ischemic stroke, heart failure, and peripheral arterial disease in type 1 diabetes mellitus(T1DM).The current study investigated the agreement between ST1RE and the Brazilian Society for Endocrinology and Metabology (SBEM) classification. Participants were included in the study if diagnosed with T1DM and had at least one outpatient visit in 2021. Patients with established cardiovascular disease and chronic kidney disease on dialysis were excluded. Clinical parameters were obtained from medical records, such as age, body mass index (BMI), blood pressure, physical activity, current smoking, microvascular target organ damage, levels of low-density lipoprotein cholesterol, creatinine, glycated hemoglobin (HbA1c), and albuminuria.Overall, 92 patients (38 males and 53 females) with an age median (P25; P75) of 33 years (25.5;42.5), BMI of 24.8 + 4.1 kg/m2, and duration of diabetes (mean ± SD) of 23.4 + 9.5 years were evaluated. There were no differences considering the gender for most analyzed variables, but a higher proportion of women exhibited microvascular complications such as microalbuminuria, macroalbuminuria, and retinopathy. Our results show a weak agreement in the 10-year cardiovascular risk estimation between SBEM and ST1RE classifications. According to SBEM criteria, 72.8% of patients were considered high-risk, while only 15.2% of patients received the same classification using ST1RE. The dissimilarities between these two classifications were also evident when age and gender factors were compared. While 60% of patients under 35 years were classified as high risk according to SBEM criteria, only 1.8% received this stratification risk in the ST1RE classification.The results indicate a low agreement between the 10-year cardiovascular event risk classification by SBEM and the classification by ST1RE for type 1 diabetes patients without established cardiovascular disease.

ABO Blood Group Type and the Risks of Peripheral Artery Disease in Type II Diabetes Mellitus

ABO Blood Group Type and the Risks of Peripheral Artery Disease in Type II Diabetes Mellitus

Remnant cholesterol is independently asssociated with an increased risk of peripheral artery disease in type 2 diabetic patients.

Remnant cholesterol (RC) has been correlated with a higher risk of atherosclerosis. It has been confirmed that in the general population, an elevated RC level is related to a 5-fold higher risk of peripheral arterial disease (PAD). Diabetes is one of the strongest risk factors for PAD development. However, the association between RC and PAD in the specific population of type 2 diabetes mellitus (T2DM) has not been investigated. Herein, the correlation was investigated between RC and PAD in T2DM patients. In the retrospective study, the hematological parameter data of 246 T2DM patients without PAD (T2DM - WPAD) and 270 T2DM patients with PAD (T2DM - PAD) was collected. Differences in RC levels between the two groups were compared, and the association between RC and PAD severity was examined. Multifactorial regression was used to determine whether RC was a significant contributor to the development of T2DM - PAD. The diagnostic potential of RC was tested using receiver operating characteristic (ROC) curve. The RC levels in T2DM - PAD individuals were considerably greater than in T2DM - WPAD individuals (P < 0.001). RC had a positive correlation with disease severity. Further, multifactorial logistic regression analyses found that elevated RC levels were a major contributor to T2DM - PAD (P < 0.001). The area under the curve (AUC) of the RC for T2DM - PAD patients was 0.727. The cut-off value of RC was 0.64 mmol/L. The RC levels were higher in T2DM - PAD patients, and were independently linked with its severity. Diabetic patients with RC levels > 0.64 mmol/L had an elevated risk of developing PAD.

Subclinical lower limb Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus: A cross-sectional study.

Background: Peripheral artery disease (PAD) is highly prevalent in patients with diabetes mellitus. The ankle-brachial index (ABI) measurement is used to diagnose peripheral arterial disease, and little is known about its prevalence in asymptomatic type 2 Diabetic patients. This study aimed to determine the prevalence of subclinical peripheral artery disease in patients with type II diabetes mellitus.&#x0D; Methodology: It was a descriptive study conducted at the Peshawar Institute of Medical Sciences, from Feb 2022 to Aug 2022. Two hundred sixty-four patients with type II diabetes (for more than three years) with no clinical features of peripheral arterial disease were assessed by measuring ankle brachial pressure index for subclinical peripheral arterial disease. Reading less than 0.9 was positive for peripheral artery disease in the lower limbs.&#x0D; Results: Peripheral Arterial Disease was present in 115 (43.6%) patients and absent in 149 (56.4%) patients. The peripheral artery disease was significantly more in males, those with age greater than 55 years, smokers, and hypertensive patients (p-value ≤ 0.05) but was not associated with the duration of diabetes or BMI of the patient (p-value &gt; 0.05)&#x0D; Conclusion: There was a high prevalence of asymptomatic peripheral artery disease in Type 2 Diabetic patients using ankle-brachial pressure index measurement. Those with ages greater than 55 years, smokers, hypertensive, and males were particularly at higher risk.

Prevalence of peripheral arterial disease in type 2 diabetes mellitus patients by ankle brachial pressure index

Introduction: Diabetes is growing at an exponential rate all around the world and soon is to be an epidemic in many countries including India. India topped the list of maximum reported cases of diabetes in year 2000 with 31.7 million (reported cases) it was followed by China (20.8 million) and the United States (17.7 million) in second and third place respectively. Material and methods: A Cross Sectional Study was done in the department of General Medicine at Muzaffarnagar Nagar Medical college, Muzaffarnagar, UP from September 2021 to August 2022. All type 2 diabetic patients attending the department were invited to participate in the study those fulfilling the inclusion criteria and giving consent for inclusion in the study during the period of study were enrolled in the study. A total of 200 such patients were recruited in the study. Measurement of ABPI was made in supine position after 10 minutes of rest and in a quiet room. Results: Out of 200 patients of type 2 diabetes mellitus, 72 (36.0%) were suffering from peripheral arterial disease. Prevalence of peripheral arterial disease in patients of type 2 diabetes mellitus in our institution (a teaching hospital) was 36.0%. Mean Fasting blood sugar levels of diabetic patients with PAD (187.90+100.64 mg/dl) was found to be higher than that of without PAD (182.15+74.29 mg/dl). Mean Post-prandial blood sugar (PPBS) levels of diabetic patients with PAD (280.58+121.11 mg/dl) were also found to be higher than that of without PAD (253.22+85.30 mg/dl). Conclusion: The findings of present study thus suggested that diabetic population is at a substantial risk of peripheral arterial disease and was significantly dependent on duration of diabetes, obesity (waist circumference) and presence of other comorbidities and complications likehypertension, retinopathy and neuropathy.

Color Doppler and Ankle-brachial Index in the Diagnosis of Peripheral Artery Disease in Type II Diabetic Subject

Objective: To determine the association of color doppler and ankle-brachial index (ABI) in the diagnosis of peripheral artery disease in type ii diabetic subject.&#x0D; Methods: The study was carried out at ultrasound department of Advanced Radiology Clinic (ARC), Karachi, from January 2020 to December 2020. Patients of diagnosed diabetes mellitus for at least 4 years of either gender between 30-70 years of age were included. All patients were instructed to avoid heavy exercise, smoking and caffeinated beverages before the examination for at the minimum of two hours. All the cases underwent Standard Doppler examination of lower limb peripheral arteries performed by radiologist having experience of more than 10 years. Spectral waveform analysis was evaluated and presence of Biphasic flow or monophasic flow on color Doppler was labelled as peripheral artery disease. The ABI was computed for each patient by measuring the systolic blood pressure in supine position starting with the right arm then proceeding towards right leg, left leg, and finally for the left arm. ABI is a ratio obtained from dividing the higher of the ankle blood pressures for each leg by the highest of the right and left arm’s brachial systolic blood pressures. It was labelled as peripheral artery disease if the value was &lt;0.9. This information along with the demographics was entered in the Performa by the researcher. Data was analyzed by using SPSS Version 26.&#x0D; Result: Mean age of enrolled participants was 58.21±6.74 year. There were 78.6% were males and 21.4% were females; mean duration of diabetes was 11.24±5.62 years. Out of all 121 cases were diagnosed color doppler and 118 cases found positive on ABI. Although ankle-brachial index shows almost similar diagnosis like color doppler ultrasound in the assessment of peripheral arterial disease (P-0.649).&#x0D; Conclusion: This study concludes that ankle-brachial index is a feasible, non-invasive technique almost similar to color Doppler ultrasound method for the detection of peripheral arterial disease. The ankle-brachial index technique is most important in periphery areas where color Doppler ultrasound is not available.

Prevalence of peripheral arterial disease in type 2 diabetes mellitus and it’s correlation with carotid intima-media thickness

Background: Peripheral arterial disease (PAD) is one of the major macrovascular complications of diabetes mellitus (DM) which is largely neglected by clinicians. DM-associated atherosclerosis can lead to complications in all major of vascular beds, including the coronary arteries, carotid vessels, and lower extremity arteries. Aims and objective were to study the prevalence of PAD in patients with type 2 DM and to study the correlation with carotid artery intima-media thicknessMethods: Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age &gt;25 year) from Dec 2019 to Oct 2021 in the various units of department of medicine or surgery, KPS institute, GSVM medical college Kanpur. Color doppler of limbs and carotid artery was done in study population.Results: In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The mean Carotid IMT (mm) (Average) was 0.82±0.16 in all diabetics. Patients with PAD have more increase in CIMT (0.95±0.12) as compare to non-PAD (0.77±0.15) p&lt;0.001.Conclusions: By using doppler, we found evidence of PAD in 25% of type 2 diabetics (M&gt;&gt;F). Patients with PAD have more increase in CIMT as compare to non-PAD.

Significant correlation of ischemic stroke with peripheral artery disease in type 2 diabetes mellitus patients

Background: Atherosclerotic disease is not only increased in incidence in type 2 diabetic patients, but its course is also accelerated. Stroke is one of the major causes of morbidity and mortality among the elderly population. The relationship between ischemic stroke and PAD (peripheral artery disease) has been poorly investigated in India. So, we studied the risk of stroke in PAD patients with type 2 diabetes. The aims and objectives of the study were to study the prevalence of PAD in patients with type 2 diabetes mellitus and to study the correlation of stroke in PAD patients with type 2 diabetes.Methods: Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age &gt;25 years) from December 2019 to October 2021 in the various units of department of medicine/surgery, KPS institute, GSVM medical college, Kanpur. Color Doppler of limbs and carotid artery was done in study population. Clinical sign and symptoms, history of stroke or diagnostic investigation were used for evaluate cerebrovascular events.Results: In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009).Conclusions: By using Doppler, we found evidence of PAD in 25% of type 2 diabetics (M&gt;F). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009). PAD is associated with an increased risk of cerebrovascular disease morbidity and mortality. Clinician should identify a PAD patient with diabetes to elicit symptoms, complications like stroke to decrease mortality or morbidity.

Prevalence and Risk Factors of Peripheral Arterial Disease in type 2 Diabets Mellitus in Yogyakarta, Indonesia

Aim:&#x0D; Diabetes mellitus increases the risk of peripheral artery disease (PAD) 2 times. PAD is diagnosed by ABI (Ankle Brachial Index). PAD increases mortality and morbidity of patient with Diabetes Mellitus (DM) Type 2. This study aims to determine the prevalence and risk factors of PAD in the population of type 2 diabetes mellitus (DM) in Yogyakarta, Indonesia.&#x0D; &#x0D; Methods:&#x0D; This study was a community-based descriptive and analytic observational study that examines the prevalence and risk factors of PAD in type 2 diabetes mellitus. Diagnosis of PAD was detected by ABI examination using VaSera VS-1500N. All patients with type 2 diabetes mellitus in Yogyakarta who meet the inclusion criteria will be enrolled in this study. The research subjects were taken in multi-stage, cluster-random sampling in Yogyakarta. The patient will undergo an interview of demographic data which were assessed by one assessor. Data from interviews and ABI examinations were analysed statistically.&#x0D; &#x0D; Results:&#x0D; Two hundred and fifty-six (256) patients with type 2 DM consisted of 188 patients (73.4%) women and 68 patients (26.6%) men. Prevalence of PAD diagnosed by abnormal ABI was found in 41 (16%) of 256 patients. Subjects with age more than 67 years old was significantly associated with PAD occurrence (P=0,001) in type 2 DM population.&#x0D; &#x0D; Conclusion:&#x0D; The prevalence of PAD was 16% of 256 type 2 DM patients. Age more than 67 years old was the strong risk factor of PAD in type 2 DM.&#x0D; &#x0D; Key words: Ankle Brachial Index, Peripheral Arterial Disease, Diabetes mellitus, Prevalence, Risk Factor

The early diagnostic value of ankle-brachial index combined with feet electrochemical skin conductance for peripheral artery disease in type 2 diabetes.

Aims/IntroductionIn this paper, we focused on exploring the diagnostic and predictive clinical utility of ankle‐brachial index (ABI) in combination with feet electrochemical skin conductance (FESC) for peripheral artery disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM).Materials and MethodsOverall, 183 Chinese T2DM patients were enrolled in this study. The patients were classified into three groups: Group 1 comprised of uncomplicated type 2 diabetics (n = 36), Group 2 consisted of patients with diabetic peripheral neuropathy (n = 103) whereas Group 3 patients displayed peripheral artery disease (n = 44). All patients underwent Sudoscan test using a Sudoscan (Paris, France) and ABI assessment.ResultsMultivariate logistic regression models revealed that FESC was an independent risk factor of developing PAD in patients with type 2 diabetes. The AUC for diagnostic, positive predictive and negative predictive value of ABI in combination with FESC for PAD were 0.907, 0.733 and 0.920, respectively. The specificity and sensitivity of ABI in combination with FESC for PAD were 0.914 and 0.750, respectively.ConclusionsAnkle‐brachial index in combination with FESC can accurately be used in early diagnosis of PAD.

Prevalence and Risk Factors for Peripheral Arterial Disease in Type 2 Diabetic Out Patients in A Care Center in Cotonou

Aim: To determine the prevalence of peripheral arterial disease and its risk factors in type 2 diabetic outpatients. Materials and Methods: It was a descriptive and analytical cross-sectional study, which included 146 diabetic out patients seen. Peripheral arterial disease (PAD) has been accessed using Ankle-Brachial Index and Arterial Doppler Ultrasound . PAD was defined by an ABI value ≤ 0.9 in either of the legs Data management and analysis were performed using Epi-Info software. A p value &lt;0.05 was considered significant. Results: The overall prevalence of peripheral arterial disease was 62.3%. Factors statistically associated with peripheral arterial disease were age (p=0.009), duration of diabetes greater than 10 years (p=0.006) and presence of peripheral neuropathy (p=0.0005). Conclusion: The prevalence of peripheral arterial disease is high in type 2 diabetic outpatients. A systematic screening and suitable management should be done in order to prevent cardiovascular events often associated.

Abstract #1003750: Risk Factors of Peripheral Arterial Disease in Type 2 Diabetes Patients: A Systematic Review and Meta-analysis

Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM), which cause serious rate of morbidities and mortality. To date, there have not been any systematic and comprehensive review regarding the risk factors of incidence of PAD in T2DM populations. Our study aims to analyze the pooled effect estimates of each risk factors of PAD incidence in T2DM populations.

Comparison of resting/postexercise ankle-brachial index and transcutaneous partial pressure of oxygen for noninvasive diagnosis of peripheral artery disease in type 2 diabetes mellitus

Background: Type 2 diabetesType 2 diabetes mellitus (T2DM) is a strong risk factor for peripheral artery disease (PAD) and PAD diagnosis in T2DM may indicate coexisting coronary artery disease as well. Postexercise ankle brachial index (ABI) and transcutaneous partial pressure of oxygen (TcPO2) have not been evaluated for PAD diagnosis among Indian T2DM patients. This study aimed to evaluate the performance of resting + postexercise(R + PE) ABI and R + PE-TcPO2 for PAD diagnosis among T2DM patients at increased PAD risk, using colour duplex ultrasound (CDU) as reference standard. MethodsThis prospectively conducted diagnostic accuracy study involved T2DM patients at increased PAD risk. R-ABI≤0.9 or PE-ABI decline >20% from resting value in those with R-ABI between 0.91 and 1.4, R–TcPO2 <30 mm Hg or PE decline of TcPO2 to <30 mm Hg in those with R–TcPO2 ≥30 mm Hg, CDU showing >50% stenosis or complete occlusion of lower extremity arteries constituted PAD. ResultsAmong 168 patients enrolled, R + PE-ABI diagnosed PAD in 19(11.3%), R + PE-TcPO2 in 61 (36.3%) and 17 (≈10%) had PAD finally confirmed by CDU. Sensitivity, specificity, PPV and NPV of R + PE-ABI for PAD diagnosis were 82.3%, 96.7%, 73.7% and 98% and that of R + PE-TcPO2 were 76.5%, 68.2%, 21.3% and 96.2%, respectively. PE-ABI increased the sensitivity of ABI by ≈ 18% and had 100% PPV for PAD. When both ABI and TcPO2 (R + PE tests) were normal, PAD could be safely excluded in 88% of patients. ConclusionPE-ABI should be routinely employed and TcPO2(R/PE) is unreliable as a stand-alone test for PAD detection among moderate to high risk T2DM patients.

Profile of Peripheral Arterial Disease in Type 2 Diabetes Mellitus - A Hospital-based observational study in Coastal Karnataka

Introduction: Ankle Brachial Index (ABI) is one of the common non-invasive diagnostic tools available for diagnosing Peripheral Arterial Disease (PAD). However, it has been observed that for an individual diagnosed with both PAD and Type 2 Diabetes Mellitus (T2DM), ABI tends to give false diagnostic value because of the calcification of the major lower limb arteries. Therefore, the health care professionals are at times misled for the diagnosis of PAD. To overcome this another diagnostic tool Toe Brachial Index (TBI) was suggested to perform. However, there is limited literature on performing both ABI and TBI in the given population in a single study.Aim:The main focus of this study is to report the profile of ABI and TBI along with classical symptoms like claudication pain, palpation of pulse and history of T2DM for the screening and diagnosis of PAD in T2DM.Materials And Methods: In this cross-sectional observational study, a total of 121 participants diagnosed with T2DM were recruited for the study as per the inclusion criteria. Detailed demographic details of the participants were noted. Diagnostic tool including both ABI and TBI were performed for all the participants and the data was analysed.Results:Among 121 participants, only 3 participants had both ABI and TBI positive indicating positive diagnostic test for PAD and 106 participants had both ABI and TBI negative. However, in the remaining 12 participants, 10 showed TBI positive but ABI negative and 2 had ABI positive but TBI negative.Conclusions: Based on our study we have reported the profile of PAD in T2DM individuals, which is found to be 10.75.%. Therefore, it can be concluded that ABI and TBI both should be performed to rule out any complication. This will be beneficial in early screening and detection of neuro ischemic changes in foot and subsequently to prevent amputation.

Plasma and Urinary Calprotectin Levels in Type 2 Diabetic Patients with Peripheral Arterial Disease

Background: Plasma calprotectin is a persistent biomarker of insulin resistance (IR), gastroenteritis, and cardiovascular disease (CVD). We assessed the role of plasma and urinary calprotectin in type 2 diabetes patients with peripheral arterial disease (PAD), to assess whether calprotectin is a risk factor for developing PAD in type 2 diabetes patients. Aim of the work: To study the association of plasma and urinary calprotectin levels with peripheral arterial disease in type 2 diabetic patients Methods: The current study was conducted on 90 subjects. They were subdivided into 3 groups. Group I: 30 type 2 diabetics with PAD, group II: 30 type 2 diabetics without PAD and group III: 30 healthy control subjects of comparable age and sex. They were subjected to history taking, full clinical examination, anthropometric measurement, plasma and urinary calprotectin levels that were measured by ELISA and ankle brachial index. In addition, HbA1c, fasting serum lipid profile, highly sensitive CRP and CBC were measured. Results: plasma calprotectin level was significantly higher in patients with T2DM with lower extremity peripheral arterial disease (LEPAD) compared to the other 2 groups, urinary calprotectin was significantly higher in all type 2 diabetic subjects compared to healthy control group. Age, current smoking status, duration of diabetes, glycated hemoglobin and plasma calprotectin were independent determinant of peripheral arterial disease in T2DM patients Conclusion: Elevated plasma and urinary calprotectin levels in diabetic patients compared to healthy control suggest the possible role of calprotectin in development of atherosclerosis and peripheral arterial disease and the possibility of its use as a biomarker for diabetic vasculopathy.

Study of association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes mellitus patients

Background: To establish association between urine albumin creatinine ratio and ankle brachial index or peripheral arterial disease in type 2 diabetes patients.Methods: Total 74 patients of type 2 diabetes mellitus of &gt;50 years of age subjected to calculation of urine albumin creatinine ratio and ankle brachial index was calculated using doppler sonography and estimation of peripheral arterial diseases was done. The data obtained subjected to analysis.Results: In group with ABI &lt;0.9 suggestive of PAD, mean age of the patient was 62.32±5.8 years, mean BMI was 26.11±2.48kg/m2, mean duration of diabetes was 11.19±41 years, 7 (18.92%) were smokers, 15 (40.54%) were insulin users, 27 (72.97%) were hypertensive, mean SBP was 142.49±13.46mmHg, mean DBP was 84±6.42mmHg, mean serum cholesterol was 221.35±17.10mg/dl, mean serum triglyceride was 242.81 ± 17.10mg/dl, mean serum HDL was 44.03±5.77mg/dl, mean serum LDL was 116.89±28.77mg/dl, mean urine ACR was 294.62±314.90mg/gm, prevalence of normoalbuminuria, microlbuminuria and macroalbuminuria was 12 (32.43%), 21 (56.76%) and 4 (10.81%) respectively. The statistical significant difference was found in age, duration of diabetes, number of patients on insulin therapy, systolic BP, serum cholesterol, triglyceride, LDL, HDL, urine ACR and distribution of albuminuria.Conclusions: we conclude that statistical significant relationship exist between urine ACR and PAD. Hence urinary ACR can be considered as surrogate marker for early prediction of PAD in elderly patients with type 2diabetes mellitus eventually leading to aggressive intervention for prevention and management.

Peripheral Artery Disease in Type 2 Diabetes Mellitus: Survival Analysis of an Ecuadorian Population in Primary Care.

BackgroundPeripheral artery disease (PAD) is associated with cardiovascular risk in type 2 diabetes mellitus (DM). The ankle-brachial index (ABI) is used for diagnosis of PAD.ObjectivesEstablish the prevalence and incidence rate for PAD and determine the associated factors and survival time for the development of PAD.MethodsRetrospective cross-sectional cohort study (follow up: 10 years) in 578 DM patients with at least 1 ABI measurement in a primary level of care diabetes clinic. Data was collected from clinical records. Sociodemographic and laboratory variables were analyzed determining its association (mean difference and bivariate logistic regression). Survival was calculated through life tables and Kaplan-Meier analysis.ResultsThe prevalence of PAD was 13.98%. The incidence rate through the time of follow up was 23.38 per 1000 person-year (95% CI: 19.91-27.26). The group that developed PAD showed higher glycated hemoglobin levels (P = .025), more years of DM (P < .001) and lower glomerular filtration rate (GFR, P = .003). The median time for developing PAD was 26.97 years (95% CI: 26.89-27.05). The risk for PAD was higher in females (95% CI: 1.51-4.38), GFR <60 mL/min/m2 (95% CI: 1.05-2.22) and use of metformin plus insulin (95% CI: 1.10-2.35).ConclusionHalf of a DM patient’s population in primary level of care will develop PAD in the third decade of disease. There are identifiable risk factors for PAD development in DM in the primary level of care such as low GFR, female sex, and use of metformin plus insulin.

Assessment of fibroblast growth factor 23 in relation to peripheral arterial disease in type 2 diabetes mellitus

BackgroundPeripheral arterial disease (PAD) is a major vascular complication and the leading cause of amputation in people with diabetes. Fibroblast growth factor 23 (FGF-23) is a recently discovered 30-kD secreted hormone glycoprotein that plays a role in the complex and tightly regulated mechanisms of mineral metabolism. Increase in serum FGF-23 concentration was an independent predictor of coronary artery diseases in patients with mild chronic kidney disease and of mortality in patients undergoing hemodialysis. Recently, FGF-23 has been found to be associated with total body atherosclerosis and vascular dysfunction.ObjectiveTo evaluate the relation between FGF-23 and PAD in patients having type 2 diabetes with normal kidney function.Patients and methodsA case-control study was conducted on 120 diabetic patients, where 60 patients having type 2 diabetes with PAD were compared with 60 patients having type 2 diabetes without PAD. All patients were subjected to full history taking, thorough clinical examination, ankle-brachial index assessment, and laboratory measurement of glycated hemoglobin%, estimated glomerular filtration rate, microalbuminuria, lipid profile, serum ionized calcium and phosphorous, and serum FGF-23.ResultsSignificantly higher serum FGF-23 was found in diabetic patients with PAD compared with diabetic patients without PAD. Logistic regression analysis showed that duration of diabetes, triglycerides level, phosphorous level, glycated hemoglobin, and FGF-23 were independent predictors for PAD.ConclusionFGF-23 level was higher in type 2 diabetic patients with PAD, which highlights a possible implication of FGF-23 in the pathogenesis of PAD in type 2 diabetes.

Vitamin D deficiency is associated with risk of developing peripheral arterial disease in type 2 diabetic patients

BackgroundThe relationship between vitamin D levels and peripheral arterial disease (PAD) remains unclear. We assessed the association of serum 25-hydroxyvitamin D (25(OH)D) levels with the prevalence of PAD in patients with type 2 diabetes mellitus(T2DM).MethodsA total of 1018 T2DM patients participated in this cross-sectional study. Serum 25(OH)D levels were measured and risk factors of PAD were recorded. PAD was diagnosed as an ankle-brachial index (ABI) < 0.9.ResultsThe mean age of the diabetic patients was 58.59 ± 11.34 years. Of all the patients, only 20.1% had a 25(OH)D level ≥ 20 ng/mL. Compared to patients without PAD, serum 25(OH)D levels were significantly lower in those with PAD (14.81 ± 8.43 vs. 11.55 ± 5.65 ng/mL, P < 0.001). The overall prevalence of PAD was 7.7%. From the highest level (≥ 20 ng/mL) to the lowest level (< 10 ng/mL) of serum 25(OH)D, the prevalence of PAD was 2.8, 7.5 and 10.7% respectively. After adjustment for age, sex, body mass index (BMI), smoking status and season, compared to patients with serum 25(OH)D levels ≥20 ng/mL, the odds ratios of PAD in patients with a level of 10 to < 20 ng/mL and < 10 ng/mL was 3.587(95% CI: 1.314–9.790) and 5.540(95% CI: 2.004–15.320), respectively. When further considering the influence of coronary heart disease (CHD), hypertension and cerebral infarction, the ratios changed to 3.824(95% CI: 1.378–10.615) and 5.729(95% CI: 2.028–16.187), respectively. And after further adjustment for the duration of diabetes, glycated hemoglobin (HbA1c) and glomerular filtration rate (GFR), the ratios changed to 3.489(95% CI: 1.100–11.062) and 3.872(95% CI: 1.168–12.841), respectively.ConclusionsReduced serum vitamin D levels were associated with an increased risk of PAD in T2DM patients. Randomized interventive clinical studies are required to verify the effects of vitamin D supplementation on PAD.