Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria.
Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Diab Vasc Dis Res. 2020 Mar-Apr;17(2):1479164120914845. doi: 10.1177/1479164120914845.
To investigate a possible beneficial effect of strict glycaemic control on all-cause mortality in patients with peripheral arterial disease and type 2 diabetes mellitus.
A total of 367 mainly older peripheral arterial disease patients [age: 69 (62-78) years, 34% women, Fontaine stage I-II] were categorized according to glycaemic control, that is, (a) no type 2 diabetes mellitus, (b) strict glucose control (HbA1c < 53 mmol/mol) and (c) lenient glucose control (HbA1c ⩾ 53 mmol/mol) at inclusion and by mean HbA1c over the first study year. Mortality was analysed using Kaplan-Meier and Cox-regression analyses after 7 years.
The combination of type 2 diabetes mellitus and peripheral arterial disease reduced survival from 78.8% to 68.9% in comparison to patients without type 2 diabetes mellitus ( = 0.023). Patients with strict glucose control (75%) were associated with increased survival in comparison to patients with lenient glucose control (58.9%) stratified by mean HbA1c ( = 0.042). Baseline cardiovascular risk factors were similar in those type 2 diabetes mellitus patients. In this peripheral arterial disease cohort HbA1c (hazard ratio: 1.3, 1.04-1.63), age (hazard ratio: 1.7, 1.3-2.3) and C-reactive protein (hazard ratio: 1.5, 1.2-2.0) remained independent associates for mortality adjusted for cardiovascular risk factors and diabetes duration.
Older patients with peripheral arterial disease and type 2 diabetes mellitus still benefit from strict glucose control in a cohort of patients with similar distribution of cardiovascular risk factors.
研究严格血糖控制对伴有 2 型糖尿病的外周动脉疾病患者全因死亡率的可能有益影响。
共纳入 367 例主要为老年外周动脉疾病患者（年龄：69（62-78）岁，34%为女性，Fontaine 分期 I-II），根据血糖控制情况进行分类，即（a）无 2 型糖尿病，（b）严格血糖控制（HbA1c＜53mmol/mol）和（c）宽松血糖控制（HbA1c≥53mmol/mol）。在纳入时和研究的第 1 年内平均 HbA1c 对患者进行分组，采用 Kaplan-Meier 和 Cox 回归分析 7 年后的死亡率。
与无 2 型糖尿病的患者相比，2 型糖尿病合并外周动脉疾病使生存率从 78.8%降至 68.9%（=0.023）。与宽松血糖控制的患者（58.9%）相比，平均 HbA1c 分层的严格血糖控制患者（75%）的生存率更高（=0.042）。2 型糖尿病患者的基线心血管危险因素相似。在外周动脉疾病队列中，HbA1c（风险比：1.3，1.04-1.63）、年龄（风险比：1.7，1.3-2.3）和 C 反应蛋白（风险比：1.5，1.2-2.0）在调整心血管危险因素和糖尿病病程后仍然是死亡的独立相关因素。
在外周动脉疾病患者中，具有相似心血管危险因素分布的患者中，年龄较大的伴有 2 型糖尿病的外周动脉疾病患者仍可从严格血糖控制中获益。
