Correlation of cumulative exposure to metabolic factors with progression of lower extremity arterial disease in type 2 diabetic patients

Abstract

Objective To investigate the correlation between cumulative exposure to metabolic factors and progression of lower extremity arterial disease (LEAD) in patients with type 2 diabetes mellitus (T2DM). Methods Clinical data of 157 T2DM patients who were hospitalized to our department for 3 consecutive years from January 2013 to March 2021 were collected and retrospectively analyzed. According to decline in ankle brachial index (ABI) during follow-up, the patients were divided into LEAD progression group (n=63) and LEAD non-progression group (n=94). Independent sample t-test or non-parametric test was adopted to compare and analyze the clinical baseline characteristics, basic values of laboratory tests and cumulative exposure values of metabolic factors between the 2 groups; Cox regression model was employed to explore the independent risk factors for LEAD progression. Results As compared with the LEAD non-progression group, the LEAD progression group had older age, longer history of diabetes and hypertension, higher prevalence of diabetic cerebrovascular disease, cardiovascular disease and peripheral neuropathy, and higher usages of medications, including lipid-regulating and anti-platelet drugs. In the LEAD progression patients, the baseline, terminal and cumulative ABI were lower, while the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher (P < 0.05), and the cumulative exposure values of SBP, DBP, total cholesterol, fasting plasma glucose, hemoglobin Alc, hypersensitive C-reactive protein, microalbumin and urinary albumin creatine ratio (UACR) were all elevated when compared with the LEAD non-progression group (P < 0.05). Multivariate Cox regression analysis indicated that diabetic cerebrovascular diseases (HR=2.448, 95%CI: 1.436~4.173, P=0.001), peripheral neuropathy (HR=2.237, 95%CI: 1.312~3.812, P=0.003), cumulative exposure value of SBP (HR=1.128, 95%CI: 1.067~1.193, P < 0.001) and that of UACR (HR=1.015, 95%CI: 1.006~1.025, P=0.001) were independent risk factors for LEAD progression. Conclusion Diabetic cerebrovascular disease, peripheral neuropathy, and increased cumulative exposure values of SBP and UACR are independent risk factors for progression of LEAD in T2DM patients. type 2 diabetes mellitus , lower extremity atheroslerotic lesions , cumulative exposure values , risk factors

Keywords

• type 2 diabetes mellitus
• lower extremity atheroslerotic lesions
• cumulative exposure values
• risk factors