scholarly journals Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes

Diabetes Care ◽  
2020 ◽  
Vol 43 (11) ◽  
pp. 2751-2759
Author(s):  
Ninon Foussard ◽  
Pierre-Jean Saulnier ◽  
Louis Potier ◽  
Stéphanie Ragot ◽  
Fabrice Schneider ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease

scholarly journals Relationship between diabetic retinopathy stages and risk of major lower-extremity arterial disease in patients with type 2 diabetes

2020 ◽  
Author(s):  
Ninon Foussard ◽  
Pierre-Jean Saulnier ◽  
Louis Potier ◽  
Stéphanie Ragot ◽  
Fabrice Schneider ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Lower Extremity ◽  
Incidence Rate ◽  
Cox Regression ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease ◽  
C Statistic

<b>Objective. </b>We evaluated the association between diabetic retinopathy stages and lower-extremity arterial disease (LEAD), its prognostic value, and the influence of potential contributors in this relationship in a prospective cohort of patients with type 2 diabetes. <p><b>Research design and methods</b><b>. </b>Diabetic retinopathy was staged at baseline as absent, non-proliferative or proliferative. Cox regression model was fitted to compute HR (95% CI) for major LEAD (lower-limb amputation or revascularization) during follow-up by baseline retinopathy stages. Retinopathy-LEAD association was assessed in subgroups by age, gender, diabetes duration, HbA1c, systolic blood pressure, diabetic kidney disease, smoking, and macrovascular disease at baseline. The performance of retinopathy to stratify LEAD risk was assessed using c-statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI).<b></b></p> <p><b>Results. </b>Among 1320 participants without a baseline history of LEAD, 94 (7.1%) patients developed a major LEAD during a 7.1-year median follow-up (incidence rate 9.6, 95%CI [7.8–11.7] per 1000 person-years). The LEAD incidence rate increased by worsening retinopathy: absent 5.5 (3.9–7.8), non-proliferative 14.6 (11.1–19.3), proliferative 20.1 (11.1–36.3) per 1000 person-years. Compared with absent retinopathy, non-proliferative (multi-adjusted HR 2.31, 95%CI [1.43–3.81], p=0.0006) and proliferative retinopathy (3.14 [1.40–6.15], p=0.007) remained associated with major LEAD. No heterogeneity was observed across subgroups. Retinopathy enhanced c-statistic (+0.023 [0.003–0.044], p=0.02), IDI (0.209 [0.130 – 0.321], p<0.001) and NRI (0.562 [0.382– 0.799], p<0.001) for LEAD risk, beyond traditional risk factors.</p> <p><b>Conclusions. </b>An independent dose-response relationship was observed between diabetic retinopathy stages and major LEAD. Retinopathy yielded incremental prognostic information for LEAD risk stratification, suggesting its usefulness as LEAD predictor.<b></b></p>

scholarly journals Relationship between diabetic retinopathy stages and risk of major lower-extremity arterial disease in patients with type 2 diabetes

2020 ◽  
Author(s):  
Ninon Foussard ◽  
Pierre-Jean Saulnier ◽  
Louis Potier ◽  
Stéphanie Ragot ◽  
Fabrice Schneider ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Lower Extremity ◽  
Incidence Rate ◽  
Cox Regression ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease ◽  
C Statistic

<b>Objective. </b>We evaluated the association between diabetic retinopathy stages and lower-extremity arterial disease (LEAD), its prognostic value, and the influence of potential contributors in this relationship in a prospective cohort of patients with type 2 diabetes. <p><b>Research design and methods</b><b>. </b>Diabetic retinopathy was staged at baseline as absent, non-proliferative or proliferative. Cox regression model was fitted to compute HR (95% CI) for major LEAD (lower-limb amputation or revascularization) during follow-up by baseline retinopathy stages. Retinopathy-LEAD association was assessed in subgroups by age, gender, diabetes duration, HbA1c, systolic blood pressure, diabetic kidney disease, smoking, and macrovascular disease at baseline. The performance of retinopathy to stratify LEAD risk was assessed using c-statistic, integrated discrimination improvement (IDI) and net reclassification improvement (NRI).<b></b></p> <p><b>Results. </b>Among 1320 participants without a baseline history of LEAD, 94 (7.1%) patients developed a major LEAD during a 7.1-year median follow-up (incidence rate 9.6, 95%CI [7.8–11.7] per 1000 person-years). The LEAD incidence rate increased by worsening retinopathy: absent 5.5 (3.9–7.8), non-proliferative 14.6 (11.1–19.3), proliferative 20.1 (11.1–36.3) per 1000 person-years. Compared with absent retinopathy, non-proliferative (multi-adjusted HR 2.31, 95%CI [1.43–3.81], p=0.0006) and proliferative retinopathy (3.14 [1.40–6.15], p=0.007) remained associated with major LEAD. No heterogeneity was observed across subgroups. Retinopathy enhanced c-statistic (+0.023 [0.003–0.044], p=0.02), IDI (0.209 [0.130 – 0.321], p<0.001) and NRI (0.562 [0.382– 0.799], p<0.001) for LEAD risk, beyond traditional risk factors.</p> <p><b>Conclusions. </b>An independent dose-response relationship was observed between diabetic retinopathy stages and major LEAD. Retinopathy yielded incremental prognostic information for LEAD risk stratification, suggesting its usefulness as LEAD predictor.<b></b></p>

Risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease in China

2020 ◽  
Author(s):  
Sanbao Chai ◽  
Xiaomei Zhang ◽  
Ning Yuan ◽  
Yufang Liu ◽  
Sixu Xin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Disease Group ◽  
Lower Extremity Arterial Disease ◽  
Depressive Patients

Abstract BackgroundWe aimed to evaluate the prevalence and risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease. Methods: Four hundred and forty-one patients with type 2 diabetes mellitus were recruited from Peking University of International Hospital. All patients completed the Self-rating Depression Scale, which includes 20 items, using a 4-point scale. Univariable and multivariable logistic regression was conducted to investigate risk factors of depression in patients with lower extremity arterial disease. Results: The prevalence of depression in lower extremity arterial disease group was significantly higher than that in non- lower extremity arterial disease group(25% vs 16%, P = 0.018). In lower extremity arterial disease group(n = 215), depression score(46.18 ± 7.38 vs 44.03 ± 6.53, P = 0.003) significantly increased compared with non lower extremity arterial disease group(n = 226). Compared with male depressive patients, the proportion of female depressive patients(38% vs 15%, P = 0.003) was significantly higher in lower extremity arterial disease group. The depression score of female depressive patients(57.83 ± 3.29 vs 55.26 ± 1.59, P = 0.003) was significantly higher than that of male depressive patients. An increased risk of depression in female patients(crude OR: 2.50, 95% CI: 1.38–4.54, P = 0.003; adjusted OR: 2.34, 95% CI: 1.26–4.36, P = 0.008) and in patients with low body mass index(crude OR: 0.88, 95% CI: 0.80–0.96, P = 0.005; adjusted OR: 0.89, 95% CI: 0.81–0.97, P = 0.011) was detected. Conclusion: Both low body mass index and female are risk factors for depression.

Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 diabetes

2020 ◽  
Vol 34 (5) ◽  
pp. 107537 ◽  
Author(s):  
Qinfen Chen ◽  
Hong Zhu ◽  
Feixia Shen ◽  
Xiaomei Zhang ◽  
Zhangrong Xu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease

Association of Circulating Osteopontin Levels With Lower Extremity Arterial Disease in Subjects With Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study

2020 ◽  
Vol 19 (2) ◽  
pp. 180-189
Author(s):  
Ioanna Eleftheriadou ◽  
Dimitrios Tsilingiris ◽  
Anastasios Tentolouris ◽  
Iordanis Mourouzis ◽  
Pinelopi Grigoropoulou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Extremity ◽  
Geometric Mean ◽  
Multivariable Analysis ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Lower Extremity Arterial Disease

Osteopontin (OPN) is involved in the atherosclerotic and inflammatory process. In this article, we examined the relationship between circulating OPN levels with lower extremity arterial disease (LEAD) in individuals with type 2 diabetes mellitus (T2DM). Seventy individuals with T2DM and 66 individuals without T2DM were recruited. Diagnosis of LEAD was based on the absence of triphasic waveform on the pedal arteries. Plasma OPN levels were determined by Luminex Multiplex immunoassay. LEAD was present in 34 (48.6%) patients with T2DM. In the diabetes cohort, individuals with LEAD had higher plasma OPN concentrations than those without LEAD (geometric mean [95% confidence intervals]; 43.4 [37.5-50.4] vs 26.1 [22.9-29.8] ng/mL, respectively, P < .001). Multivariable analysis showed that presence of LEAD independently associated with higher OPN levels in subjects with T2DM, with marginal statistical significance ( P = .049). In both cohorts, plasma OPN concentrations were negatively associated with ankle-brachial index values ( P < .05). In the total sample, there was a gradual increase of OPN levels across subgroups with triphasic, biphasic, and monophasic/blunted waveforms ( P < .001). In conclusion, plasma OPN levels are associated with the presence and severity of LEAD in subjects with T2DM. Further studies are needed to investigate the role of OPN in the pathogenesis and progression of LEAD.

scholarly journals Efficacy and Safety of Adjunctive Cilostazol to Clopidogrel‐Treated Diabetic Patients With Symptomatic Lower Extremity Artery Disease in the Prevention of Ischemic Vascular Events

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kallirroi Kalantzi ◽  
Nikolaos Tentolouris ◽  
Andreas J. Melidonis ◽  
Styliani Papadaki ◽  
Michail Peroulis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Extremity ◽  
Arterial Disease ◽  
Efficacy And Safety ◽  
Vascular Events ◽  
Lower Extremity Arterial Disease ◽  
Ischemic Attack

Background Type 2 diabetes mellitus is a risk factor for lower extremity arterial disease. Cilostazol expresses antiplatelet, anti‐inflammatory, and vasodilator actions and improves the claudication intermittent symptoms. We investigated the efficacy and safety of adjunctive cilostazol to clopidogrel‐treated patients with type 2 diabetes mellitus exhibiting symptomatic lower extremity arterial disease, in the prevention of ischemic vascular events and improvement of the claudication intermittent symptoms. Methods and Results In a prospective 2‐arm, multicenter, open‐label, phase 4 trial, patients with type 2 diabetes mellitus with intermittent claudication receiving clopidogrel (75 mg/d) for at least 6 months, were randomly assigned in a 1:1 ratio, either to continue to clopidogrel monotherapy, without receiving placebo cilostazol (391 patients), or to additionally receive cilostazol, 100 mg twice/day (403 patients). The median duration of follow‐up was 27 months. The primary efficacy end point, the composite of acute ischemic stroke/transient ischemic attack, acute myocardial infarction, and death from vascular causes, was significantly reduced in patients receiving adjunctive cilostazol compared with the clopidogrel monotherapy group (sex‐adjusted hazard ratio [HR], 0.468; 95% CI, 0.252–0.870; P =0.016). Adjunctive cilostazol also significantly reduced the stroke/transient ischemic attack events (sex‐adjusted HR, 0.38; 95% CI, 0.15–0.98; P =0.046) and improved the ankle‐brachial index and pain‐free walking distance values ( P =0.001 for both comparisons). No significant difference in the bleeding events, as defined by Bleeding Academic Research Consortium criteria, was found between the 2 groups (sex‐adjusted HR, 1.080; 95% CI, 0.579–2.015; P =0.809). Conclusions Adjunctive cilostazol to clopidogrel‐treated patients with type 2 diabetes mellitus with symptomatic lower extremity arterial disease may lower the risk of ischemic events and improve intermittent claudication symptoms, without increasing the bleeding risk, compared with clopidogrel monotherapy. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02983214.

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