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Association of impaired fasting glucose, diabetes and their management with the presentation and outcome of peripheral artery disease: a cohort study.

Golledge J, Quigley F, Velu R, Walker PJ, Moxon JV - Cardiovasc Diabetol (2014)

Bottom Line: Patients were followed for a median of 1.7 years.Non-medicated diabetes is common in peripheral artery disease patients and associated with poor outcomes.Impaired fasting glucose is also common but does not increase intermediate term complications.

View Article: PubMed Central - PubMed

Affiliation: Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia, 4811. jonathan.golledge@jcu.edu.au.

ABSTRACT

Background: Pre-diabetes and untreated diabetes are common in patients with peripheral artery disease however their impact on outcome has not been evaluated. We examined the association of impaired fasting glucose, diabetes and their treatment with the presentation, mortality and requirement for intervention in peripheral artery disease patients.

Methods: We prospectively recruited 1637 patients with peripheral artery disease, measured fasting glucose, recorded medications for diabetes and categorised them by diabetes status. Patients were followed for a median of 1.7 years.

Results: At entry 22.7% patients were receiving treatment for type 2 diabetes by oral hypoglycaemics alone (18.1%) or insulin (4.6%). 9.2% patients had non-medicated diabetes. 28.1% of patients had impaired fasting glucose (5.6-6.9 mM). Patients with non-medicated diabetes had increased mortality and requirement for peripheral artery intervention (hazards ratio 1.62 and 1.31 respectively). Patients with diabetes prescribed insulin had increased mortality (hazard ratio 1.97). Patients with impaired fasting glucose or diabetes prescribed oral hypoglycaemics only had similar outcomes to patients with no diabetes.

Conclusions: Non-medicated diabetes is common in peripheral artery disease patients and associated with poor outcomes. Impaired fasting glucose is also common but does not increase intermediate term complications. Peripheral artery disease patients with diabetes requiring insulin are at high risk of intermediate term mortality.

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Related in: MedlinePlus

Kaplan Meier curves showing the cumulative proportional requirement for peripheral artery intervention in relation to diabetes categories. Lines represent requirement for peripheral artery intervention for subjects grouped by diabetes categories. The blue, green, black, purple and red lines represent no diabetes, impaired fasting glucose, non-medicated diabetes, diabetes prescribed oral hypoglycaemics only and diabetes prescribed insulin, respectively. Vertical lines represent subjects censored at loss to follow-up.
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Fig2: Kaplan Meier curves showing the cumulative proportional requirement for peripheral artery intervention in relation to diabetes categories. Lines represent requirement for peripheral artery intervention for subjects grouped by diabetes categories. The blue, green, black, purple and red lines represent no diabetes, impaired fasting glucose, non-medicated diabetes, diabetes prescribed oral hypoglycaemics only and diabetes prescribed insulin, respectively. Vertical lines represent subjects censored at loss to follow-up.

Mentions: During follow up, 963 (58.8%) patients required a peripheral artery intervention. Patients with non-medicated diabetes were more likely to require a peripheral artery intervention during follow-up (Figure 2). Kaplan Meier analyses suggested that by two years after entry 69.3% of these patients had required a peripheral artery intervention. This intervention requirement was significantly greater than for patients with no diabetes (57.4%; p = 0.008) and those with diabetes prescribed oral hypoglycaemics only (57.1%; p = 0.018), and almost significantly higher than for patients prescribed insulin (60.1%; p = 0.063). The intervention rate in patients with impaired fasting glucose (63.9%; p = 0.210) was similar to that of patients with non-medicated diabetes (Figure 2). Cox proportional hazard analyses suggested that the requirement for peripheral artery intervention was approximately 1.3-fold greater in patients with non-medicated diabetes compared to those with no diabetes in different models which included adjustment for other risk factors (Table 3). The requirement for peripheral artery intervention was similar in patients with impaired fasting glucose, diabetes prescribed oral hypoglycaemics only, diabetes prescribed insulin and no diabetes (Table 3).Figure 2


Association of impaired fasting glucose, diabetes and their management with the presentation and outcome of peripheral artery disease: a cohort study.

Golledge J, Quigley F, Velu R, Walker PJ, Moxon JV - Cardiovasc Diabetol (2014)

Kaplan Meier curves showing the cumulative proportional requirement for peripheral artery intervention in relation to diabetes categories. Lines represent requirement for peripheral artery intervention for subjects grouped by diabetes categories. The blue, green, black, purple and red lines represent no diabetes, impaired fasting glucose, non-medicated diabetes, diabetes prescribed oral hypoglycaemics only and diabetes prescribed insulin, respectively. Vertical lines represent subjects censored at loss to follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230372&req=5

Fig2: Kaplan Meier curves showing the cumulative proportional requirement for peripheral artery intervention in relation to diabetes categories. Lines represent requirement for peripheral artery intervention for subjects grouped by diabetes categories. The blue, green, black, purple and red lines represent no diabetes, impaired fasting glucose, non-medicated diabetes, diabetes prescribed oral hypoglycaemics only and diabetes prescribed insulin, respectively. Vertical lines represent subjects censored at loss to follow-up.
Mentions: During follow up, 963 (58.8%) patients required a peripheral artery intervention. Patients with non-medicated diabetes were more likely to require a peripheral artery intervention during follow-up (Figure 2). Kaplan Meier analyses suggested that by two years after entry 69.3% of these patients had required a peripheral artery intervention. This intervention requirement was significantly greater than for patients with no diabetes (57.4%; p = 0.008) and those with diabetes prescribed oral hypoglycaemics only (57.1%; p = 0.018), and almost significantly higher than for patients prescribed insulin (60.1%; p = 0.063). The intervention rate in patients with impaired fasting glucose (63.9%; p = 0.210) was similar to that of patients with non-medicated diabetes (Figure 2). Cox proportional hazard analyses suggested that the requirement for peripheral artery intervention was approximately 1.3-fold greater in patients with non-medicated diabetes compared to those with no diabetes in different models which included adjustment for other risk factors (Table 3). The requirement for peripheral artery intervention was similar in patients with impaired fasting glucose, diabetes prescribed oral hypoglycaemics only, diabetes prescribed insulin and no diabetes (Table 3).Figure 2

Bottom Line: Patients were followed for a median of 1.7 years.Non-medicated diabetes is common in peripheral artery disease patients and associated with poor outcomes.Impaired fasting glucose is also common but does not increase intermediate term complications.

View Article: PubMed Central - PubMed

Affiliation: Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia, 4811. jonathan.golledge@jcu.edu.au.

ABSTRACT

Background: Pre-diabetes and untreated diabetes are common in patients with peripheral artery disease however their impact on outcome has not been evaluated. We examined the association of impaired fasting glucose, diabetes and their treatment with the presentation, mortality and requirement for intervention in peripheral artery disease patients.

Methods: We prospectively recruited 1637 patients with peripheral artery disease, measured fasting glucose, recorded medications for diabetes and categorised them by diabetes status. Patients were followed for a median of 1.7 years.

Results: At entry 22.7% patients were receiving treatment for type 2 diabetes by oral hypoglycaemics alone (18.1%) or insulin (4.6%). 9.2% patients had non-medicated diabetes. 28.1% of patients had impaired fasting glucose (5.6-6.9 mM). Patients with non-medicated diabetes had increased mortality and requirement for peripheral artery intervention (hazards ratio 1.62 and 1.31 respectively). Patients with diabetes prescribed insulin had increased mortality (hazard ratio 1.97). Patients with impaired fasting glucose or diabetes prescribed oral hypoglycaemics only had similar outcomes to patients with no diabetes.

Conclusions: Non-medicated diabetes is common in peripheral artery disease patients and associated with poor outcomes. Impaired fasting glucose is also common but does not increase intermediate term complications. Peripheral artery disease patients with diabetes requiring insulin are at high risk of intermediate term mortality.

Show MeSH
Related in: MedlinePlus