College of Health Sciences, University of Abuja, Abuja, Nigeria.
College of Health Sciences, University of Abuja, Abuja, Nigeria.
Foot (Edinb). 2023 May;55:101987. doi: 10.1016/j.foot.2023.101987. Epub 2023 Mar 1.
Peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) are two of the leading causes of non-traumatic amputation worldwide with tremendous negative effects on the quality of life, psychosocial well-being of persons with diabetes mellitus; and a great burden on health care expenditure. It is therefore imperative, to identify the common and contrast determinants of PAD and DPN in order to ease adoption of common and specific strategies for their early prevention.
This was a multi-center cross-sectional study which involved the consecutive enrolment of one thousand and forty (1040) participants following consent and waiver of ethical approval. Relevant medical history, anthropometric measurements, other clinical examinations including measurement of ankle-brachial index (ABI) and neurological examinations were undertaken. IBM SPSS version 23 was used for statistical analysis and logistic regression was used to assess for the common and contrast determinants of PAD and DPN. Significance level used was p < 0.05.
Multiple stepwise logistic regression showed that common predictors of PAD vs DPN respectively include age, odds ratio (OR) 1.51 vs 1.99, 95 % confidence interval (CI) 1.18-2.34 vs 1.35-2.54, p = 0.033 vs 0.003; duration of DM (OR 1.51 vs 2.01, CI 1.23-1.85 vs 1.00-3.02, p = <.001 vs 0.032); central obesity (OR 9.77 vs 1.12, CI 5.07-18.82 vs 1.08-3.25, p = <.001 vs 0.047); poor SBP control (OR 2.47 vs 1.78, CI 1.26-4.87 vs 1.18-3.31, p = .016 vs 0.001); poor DBP control (OR 2.45 vs 1.45, CI 1.24-4.84 vs 1.13-2.59, p = .010 vs 0.006); poor 2HrPP control (OR 3.43 vs 2.83, CI 1.79-6.56 vs 1.31-4.17, p = <.001 vs 0.001); poor HbA1c control (OR 2.59 vs 2.31, CI 1.50-5.71 vs 1.47-3.69, p = <.001 vs 0.004). Common negative predictors or probable protective factors of PAD and DPN respectively include statins (OR 3.01 vs 2.21, CI 1.99-9.19 vs 1.45-3.26, p = .023 vs 0.004); and antiplatelets (OR 7.14 vs 2.46, CI 3.03-15.61 vs 1.09-5.53, p = .008 vs 0.030). However, only DPN was significantly predicted by female gender (OR 1.94, CI 1.39-2.25, p = 0.023), height (OR 2.02, CI 1.85-2.20, p = 0.001), generalized obesity (OR 2.02, CI 1.58-2.79, p = 0.002), and poor FPG control (OR 2.43, CI 1.50-4.10, p = 0.004) CONCLUSION: Common determinants of PAD and DPN included age, duration of DM, central obesity, and poor control of SBP, DBP, and 2HrPP control. Additionally, the use of antiplatelets and statins use were common inverse determinants of PAD and DPN which means they may help protect against PAD and DPN. However, only DPN was significantly predicted by female gender, height, generalized obesity, and poor control of FPG.
外周动脉疾病（PAD）和糖尿病周围神经病变（DPN）是全球导致非创伤性截肢的两个主要原因，对糖尿病患者的生活质量、社会心理健康有巨大的负面影响，同时也给医疗保健支出带来了巨大的负担。因此，确定 PAD 和 DPN 的共同和对比决定因素对于减轻其早期预防的通用和特定策略的采用至关重要。
这是一项多中心横断面研究，涉及在同意并放弃伦理批准的情况下连续纳入 1040 名参与者。进行了相关的病史、人体测量学测量、其他临床检查，包括踝臂指数（ABI）测量和神经学检查。使用 IBM SPSS 版本 23 进行统计分析，使用逻辑回归评估 PAD 和 DPN 的共同和对比决定因素。使用的显著性水平为 p<0.05。
多步逻辑回归显示，PAD 与 DPN 的共同预测因素分别为年龄，比值比（OR）分别为 1.51 比 1.99，95%置信区间（CI）分别为 1.18-2.34 比 1.35-2.54，p=0.033 比 0.003；糖尿病持续时间（OR 1.51 比 2.01，CI 1.23-1.85 比 1.00-3.02，p<0.001 比 0.032）；中心性肥胖（OR 9.77 比 1.12，CI 5.07-18.82 比 1.08-3.25，p<0.001 比 0.047）；收缩压控制不佳（OR 2.47 比 1.78，CI 1.26-4.87 比 1.18-3.31，p=0.016 比 0.001）；舒张压控制不佳（OR 2.45 比 1.45，CI 1.24-4.84 比 1.13-2.59，p=0.010 比 0.006）；2 小时餐后血糖控制不佳（OR 3.43 比 2.83，CI 1.79-6.56 比 1.31-4.17，p<0.001 比 0.001）；糖化血红蛋白控制不佳（OR 2.59 比 2.31，CI 1.50-5.71 比 1.47-3.69，p<0.001 比 0.004）。PAD 和 DPN 的共同负预测因素或可能的保护因素分别为他汀类药物（OR 3.01 比 2.21，CI 1.99-9.19 比 1.45-3.26，p=0.023 比 0.004）和抗血小板药物（OR 7.14 比 2.46，CI 3.03-15.61 比 1.09-5.53，p=0.008 比 0.030）。然而，只有 DPN 被女性（OR 1.94，CI 1.39-2.25，p=0.023）、身高（OR 2.02，CI 1.85-2.20，p=0.001）、全身性肥胖（OR 2.02，CI 1.58-2.79，p=0.002）和空腹血糖控制不佳（OR 2.43，CI 1.50-4.10，p=0.004）显著预测。
PAD 和 DPN 的共同决定因素包括年龄、糖尿病持续时间、中心性肥胖以及收缩压、舒张压和 2 小时餐后血糖控制不佳。此外，抗血小板药物和他汀类药物的使用是 PAD 和 DPN 的共同逆定因素，这意味着它们可能有助于预防 PAD 和 DPN。然而，只有 DPN 被女性、身高、全身性肥胖和空腹血糖控制不佳显著预测。
