Association of impaired fasting glucose, diabetes and their management with the presentation and outcome of peripheral artery disease: a cohort study - PubMed (original) (raw)

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

Jonathan Golledge et al. Cardiovasc Diabetol. 2014.

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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Figures

Figure 1

Figure 1

Kaplan Meier curves showing the cumulative proportional mortality in relation to diabetes categories. Lines represent mortality 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.

Figure 2

Figure 2

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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