Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará, 66073-000, Brazil.
BMC Cardiovasc Disord. 2022 Jun 27;22(1):294. doi: 10.1186/s12872-022-02722-6.
Little is known about the evolution of peripheral arterial disease (PAD) since diagnosis and its association with glycemic and lipid control in patients with Type 2 Diabetes Mellitus (T2DM).
Evaluate the actual criteria to start screening PAD with ankle-brachial index (ABI) in T2DM patients and assess its progression and relationship with glycemic and lipid control since diagnosis.
We performed a 3-year prospective cohort study with two groups: group 1 (978 individuals with T2DM undergoing drug treatment) and group 2 [221 newly diagnosed drug-naive (< 3 months) patients with T2DM]. PAD diagnosis was by ABI ≤ 0.90, regardless any symptoms.
As expected, abnormal ABI prevalence was higher in group 1 vs. Group 2 (87% vs. 60%, p < 0.001). However, abnormal ABI prevalence did not differ between patients over and under 50 years in both groups. Our drug-naive group stabilizes ABI (0.9 ± 0.1 vs 0.9 ± 0.1, p = NS) and improved glycemic and lipid control during follow-up [glycated hemoglobin (HbA1c) = 8.9 ± 2.1 vs 8.4 ± 2.3%, p < 0.05; LDL = 132 ± 45 vs 113 ± 38 mg/dL, p < 0.01, respectively]. When compared, patients who evolved with normalization or maintained normal ABI levels at the end [Group A, N = 60 (42%)] with those who decreased ABI to abnormal levels (ABI basal 1.0 ± 0.1 vs final 0.85 ± 0.1, p < 0.001) [Group B, N = 26 (18%)], an improvement in HbA1c (9 ± 2 vs 8 ± 2%, p < 0.05) and a correlation between the final HbA1c with ABI (r = - 0.3, p = 0.01) was found only in the first. In addition, a correlation was found between albuminuria variation and ABI solely in group A (r = - 0.3; p < 0.05).
Our study suggests that ABI should be measured at diagnosis in T2DM patients, indicating that current criteria to select patients to screen PAD with ABI must be simplified. An improvement in albuminuria and glycemic and lipid control could be related with ABI normalization in newly diagnosed T2DM drug-naive patients.
自诊断以来，外周动脉疾病（PAD）的演变及其与 2 型糖尿病（T2DM）患者血糖和血脂控制的关系知之甚少。
评估使用踝肱指数（ABI）开始筛查 T2DM 患者 PAD 的实际标准，并评估其自诊断以来的进展及其与血糖和血脂控制的关系。
我们进行了一项为期 3 年的前瞻性队列研究，分为两组：组 1（978 名接受药物治疗的 T2DM 患者）和组 2[221 名新诊断的药物初治（<3 个月）T2DM 患者]。PAD 的诊断标准为 ABI≤0.90，无论有无症状。
不出所料，组 1 的异常 ABI 患病率高于组 2（87% vs. 60%，p<0.001）。然而，两组中 50 岁以上和 50 岁以下患者的异常 ABI 患病率无差异。我们的初治组在随访期间稳定了 ABI（0.9±0.1 与 0.9±0.1，p=NS）并改善了血糖和血脂控制[糖化血红蛋白（HbA1c）=8.9±2.1 与 8.4±2.3%，p<0.05；LDL=132±45 与 113±38 mg/dL，p<0.01]。相比之下，在结束时 ABI 正常或保持正常水平的患者[组 A，N=60（42%）]与 ABI 降低至异常水平的患者[ABI 基础值 1.0±0.1 与最终值 0.85±0.1，p<0.001]相比，HbA1c 有所改善（9±2 与 8±2%，p<0.05），并且最终 HbA1c 与 ABI 之间存在相关性（r=-0.3，p=0.01）仅在第一组中发现。此外，仅在组 A 中发现白蛋白尿变化与 ABI 之间存在相关性（r=-0.3；p<0.05）。
我们的研究表明，T2DM 患者应在诊断时测量 ABI，这表明目前使用 ABI 选择 PAD 筛查患者的标准必须简化。新诊断的药物初治 T2DM 患者的白蛋白尿和血糖及血脂控制改善可能与 ABI 正常化有关。
