Faculty of Medicine Turku University Hospital University of Turku TE5, Hameentie 11 20521 Turku Finland. Department of Surgery, Satakunta Central Hospital, Pori, Finland.
Department of Internal Medicine, University of Turku, Turku, Finland Division of Medicine, Turku University Hospital, Turku, Finland.
Scand J Surg. 2021 Dec;110(4):472-482. doi: 10.1177/1457496920968679. Epub 2020 Nov 23.
Diabetes mellitus associates with poor outcomes in chronic limb threatening ischemia but data on different hypoglycemic regimens and outcomes are lacking. We analyzed insulin-treated diabetes mellitus, non-insulin-treated diabetes mellitus, and patients without diabetes mellitus.
All patients with peripheral artery disease and/or diabetes mellitus and infrapopliteal revascularization in the Department of Vascular Surgery, Turku University Hospital during 2007-2015 were included. Tibial atherosclerosis was categorized into crural index classes of I-IV.
Of the 497 patients, 180 were insulin-treated diabetes mellitus, 94 non-insulin-treated diabetes mellitus, and 223 patients without diabetes mellitus groups (diabetes mellitus 55.1%). Insulin-treated diabetes mellitus was the most ill, youngest (insulin-treated diabetes mellitus-median: 72.4, interquartile range: 64.0-79.5 versus non-insulin-treated diabetes mellitus-76.0, interquartile range: 67.9-83.6 versus patients without diabetes mellitus-77.3, interquartile range: 68.5-83.7, < 0.001), had the highest body mass index (insulin-treated diabetes mellitus-median: 27.7, interquartile range: 24.0-31.8 versus non-insulin-treated diabetes mellitus-26.3, interquartile range: 23.2-30.3 versus patients without diabetes mellitus-23.9, interquartile range: 21.5-26.9, < 0.001), and Charlson comorbidity index (insulin-treated diabetes mellitus-65.6% versus non-insulin-treated diabetes mellitus-46.8% versus patients without diabetes mellitus-10.8%, < 0.001). After endovascular revascularization, limb salvage was poorer for insulin-treated diabetes mellitus ( = 0.046) and non-insulin-treated diabetes mellitus groups ( = 0.011) compared to surgery, but not for patients without diabetes mellitus ( = 0.15). Patients with crural index IV in insulin-treated diabetes mellitus ( = 0.001) and non-insulin-treated diabetes mellitus ( = 0.013) had higher mortality after revascularization. Crural index IV was a risk factor for limb loss (hazard ratio: 1.37, 95% confidence interval: 1.08-1.74, = 0.008).
Limb salvage after bypass is better for insulin and non-insulin diabetics, compared to the endovascular approach. Extensive tibial atherosclerosis is an independent risk factor for limb loss. It associates with increased mortality in both insulin and non-insulin diabetics.
糖尿病与慢性肢体威胁性缺血的不良结局相关，但有关不同降糖方案和结局的数据尚缺乏。我们分析了胰岛素治疗的糖尿病、非胰岛素治疗的糖尿病和无糖尿病患者。
所有在 2007 年至 2015 年间在图尔库大学医院血管外科接受外周动脉疾病和/或糖尿病及胫下血管重建的患者均被纳入研究。胫动脉粥样硬化分为 crural index 分级 I-IV 级。
497 例患者中，180 例为胰岛素治疗的糖尿病，94 例为非胰岛素治疗的糖尿病，223 例为无糖尿病患者（糖尿病患者占 55.1%）。胰岛素治疗的糖尿病患者病情最严重、最年轻（胰岛素治疗的糖尿病中位数：72.4，四分位间距：64.0-79.5 岁；非胰岛素治疗的糖尿病中位数：76.0，四分位间距：67.9-83.6 岁；无糖尿病患者中位数：77.3，四分位间距：68.5-83.7 岁， < 0.001），体重指数最高（胰岛素治疗的糖尿病中位数：27.7，四分位间距：24.0-31.8 岁；非胰岛素治疗的糖尿病中位数：26.3，四分位间距：23.2-30.3 岁；无糖尿病患者中位数：23.9，四分位间距：21.5-26.9 岁， < 0.001），且 Charlson 合并症指数（胰岛素治疗的糖尿病为 65.6%；非胰岛素治疗的糖尿病为 46.8%；无糖尿病患者为 10.8%， < 0.001）也最高。血管内重建后，与手术相比，胰岛素治疗的糖尿病（ = 0.046）和非胰岛素治疗的糖尿病（ = 0.011）患者的肢体存活率更差，但无糖尿病患者（ = 0.15）的存活率无差异。胰岛素治疗的糖尿病（ = 0.001）和非胰岛素治疗的糖尿病（ = 0.013）患者 crural index 分级为 IV 级时，血管重建后的死亡率更高。Crural index 分级 IV 是肢体丧失的危险因素（风险比：1.37，95%置信区间：1.08-1.74， = 0.008）。
与血管内治疗相比，旁路手术后胰岛素和非胰岛素治疗的糖尿病患者的肢体存活率更好。广泛的胫动脉粥样硬化是肢体丧失的独立危险因素。它与胰岛素和非胰岛素治疗的糖尿病患者的死亡率增加有关。
