Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Diabetes, Obesity and Human Reproduction Research Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
Diabetes Metab Res Rev. 2019 Feb;35(2):e3088. doi: 10.1002/dmrr.3088. Epub 2018 Nov 20.
Epidemiological data on subclinical atherosclerotic disease in type 1 diabetes mellitus (DM1) are scarce. We aimed to estimate the subclinical atherosclerosis profile of asymptomatic patients with DM1 and an abnormal ankle-brachial index (ABI).
In a cross-sectional design (ClinicalTrials.gov Identifier: NCT02910271), we estimated ABI in 289 consecutive asymptomatic patients with DM1. An abnormal ABI led to measurements of toe-brachial index (TBI) and peripheral doppler ultrasound (DUS) to diagnose peripheral artery disease (PAD) and/or atherosclerotic carotid plaques (ACP).
A reduced (≤0.9) or increased (>1.2) ABI was detected in 17 (6%) and 75 (26%) patients, respectively. PAD was confirmed by TBI and DUS in 9 (53%) patients with a reduced ABI and 28 (37%) patients with an increased ABI, resulting in a 12.8% (9.4-17.2) prevalence of asymptomatic PAD. Fourteen patients with an abnormal ABI also exhibited ACP [4.8% (2.9-7.9)], with 64% of these patients showing bilateral disease. Artery stenosis was mild or moderate in 21% and 29% of patients, respectively. Thus, 46 [16% (12-21)] patients showed asymptomatic PAD, ACP, or both. According to our data, we would have to explore three asymptomatic patients with DM1 and normal pulses to unmask one case of PAD, and seven asymptomatic patients showing abnormal ABI values to detect one carotid disease.
Peripheral artery disease is often undiagnosed in asymptomatic patients with DM1. However, its presence may change medical management in a substantial percentage of cases, highlighting the potential benefit of a thorough vascular assessment on these patients.
1 型糖尿病（DM1）患者亚临床动脉粥样硬化疾病的流行病学数据较为缺乏。本研究旨在评估无症状 DM1 患者和踝臂指数（ABI）异常患者的亚临床动脉粥样硬化情况。
采用横断面设计（ClinicalTrials.gov 标识符：NCT02910271），我们对 289 例连续的无症状 DM1 患者进行了 ABI 测量。ABI 异常的患者进一步进行了趾臂指数（TBI）和外周多普勒超声（DUS）检查，以诊断外周动脉疾病（PAD）和/或动脉粥样硬化性颈动脉斑块（ACP）。
ABI 降低（≤0.9）或升高（>1.2）分别见于 17（6%）和 75（26%）例患者。ABI 降低的 9 例（53%）和 ABI 升高的 28 例（37%）患者通过 TBI 和 DUS 确诊为 PAD，无症状 PAD 的总患病率为 12.8%（9.4-17.2）。ABI 异常的 14 例患者还存在 ACP[4.8%（2.9-7.9%）]，其中 64%的患者存在双侧病变。21%和 29%的患者动脉狭窄程度分别为轻度或中度。因此，46 例[16%（12-21）]患者存在无症状 PAD、ACP 或两者兼有。根据我们的数据，如果要发现无症状 DM1 患者中的 1 例 PAD，需要检查 3 例无症状且脉搏正常的患者；如果要检出 1 例颈动脉疾病，需要检查 7 例 ABI 值异常的无症状患者。
无症状 DM1 患者中常漏诊 PAD，但在很大一部分患者中，其存在可能会改变治疗策略，这凸显了对这些患者进行全面血管评估的潜在获益。
