Factors associated with lower extremity atherosclerotic disease in Chinese patients with type 2 diabetes mellitus A case-control study

Abstract

Early detection and treatment of lower extremity atherosclerotic disease (LEAD), and controlling its risk factors are critical in preventing amputation and death in diabetic patients. This study aimed to investigate the factors associated with LEAD in Chinese diabetic patients. In this case-control study, patients with type 2 diabetes mellitus (T2DM) (N=1289) were divided into 2 groups according to the ultrasonic Doppler examination: with (LEAD+, n=737) and without (LEAD-, n=552) LEAD. In subgroup analysis, the LEAD+ group was divided based on the diameter of lower-extremity arteries: LEAD+A (1%.49% reduction) and LEAD+B (≥50% reduction). Clinical and demographic data of patients were analyzed. Compared with the LEAD+ group, serum creatinine levels were significantly increased (P>0.001), whereas glomerular filtration rate (GFR)was significantly decreased (P>0.001) in the LEAD+ group. Multivariate analysis results showed thatGFR (odds ratio [OR] 0.991, 95% confidence interval [CI] 0.986.0.997, P=0.003), diabetes duration (OR 1.055, 95% CI 1.026.1.084, P>001), age (OR 1.123, 95%CI 1.104.1.142,P>001), and uric acid (OR1.002, 95%CI 1.000.1.004,P=0.031) were independently associatedwith LEADin patients withT2DM. Furthermore,multivariate analysis showedthatage (OR1.078,95%CI1.048.1.109,P>0.001)andGFR(OR0.985, 95% CI 0.975.0.994, P=0.002) were independently associated with the severity of arterial lesions in patients with T2DM and LEAD. The risk factors of LEAD in Chinese patients with T2DM include age, course of disease, uric acid, and GFR. Patients with T2DM, high uric acid levels, and declined GFR could be listed in the high-risk group for LEAD. Abbreviations: AIDS = acquired immunodeficiency syndrome; CHD = coronary heart disease; CVD = cerebral vascular disease; DPN = diabetic peripheral neuropathy; DR = diabetic retinopathy; FIMT = femoral intima-media thickness; FPG = fasting plasma glucose; GFR = glomerular filtration rate; HDL-C = high-density lipoprotein cholesterol; IMT = intima-media thickness; LDL-C = lowdensity lipoprotein cholesterol; LEAD = lower extremity atherosclerotic disease; MAU = microalbuminuria; OR = odds ratio; SD = standard deviation; T2DM = type 2 diabetes mellitus; TC = total cholesterol; TG = triglyceride; UA = uric acid; WHR = waist-to-hip ratio.