Impact of diabetes type on treatment and outcome of patients with peripheral artery disease

Richter, Lars; Freisinger, Eva; Lüders, Florian; Gebauer, Katrin; Meyborg, Matthias; Malyar, Nasser

doi:10.1177/1479164118793986

Cited by 24 publications

(16 citation statements)

References 16 publications

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“…However, it is important to identify PAD in patients with diabetic foot ulceration (DFU) at the earliest possible stage, as the presence of PAD is associated with increased risk of nonhealing ulcers, infection, and major limb amputation, as well as an elevated risk of cardiovascular morbidity and overall mortality. [10][11][12][13][14] The prognosis of a patient with diabetes, PAD, and foot ulceration requiring amputation is worse than many common cancers-up to 50% of patients will not survive 5 years. 4,15 There are several guidelines for the management of patients with PAD and chronic limb-threatening ischaemia (CLTI).…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic tests may be less reliable due to the presence of peripheral neuropathy, medial arterial calcification, and peripheral oedema. However, it is important to identify PAD in patients with diabetic foot ulceration (DFU) at the earliest possible stage, as the presence of PAD is associated with increased risk of nonhealing ulcers, infection, and major limb amputation, as well as an elevated risk of cardiovascular morbidity and overall mortality . The prognosis of a patient with diabetes, PAD, and foot ulceration requiring amputation is worse than many common cancers—up to 50% of patients will not survive 5 years …”

Section: Introductionmentioning

confidence: 99%

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Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

257

262

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which confers a significantly elevated risk of adverse limb events and cardiovascular disease. We know that the diagnosis, prognosis, and treatment of these patients are markedly different to patients with diabetes who do not have PAD and yet there are few good quality studies addressing this important subset of patients. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to devise clinical questions and critically important outcomes in the patient‐intervention‐comparison‐outcome (PICO) format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We here present the updated 2019 guidelines on diagnosis, prognosis, and management of PAD in patients with a foot ulcer and diabetes, and we suggest some key future topics of particular research interest.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Hinchliffe

Forsythe

Apelqvist

et al. 2020

Diabetes Metabolism Res

257

262

View full text Add to dashboard Cite

show abstract

“…The combination of diabetes and PAD substantially increases the risk of amputation or non‐healing and of cardiovascular mortality . In the Eurodiale study, patients with a foot ulcer and PAD, when compared with ulcer patients without PAD, had healing rates of 69% vs 84% and major amputation rates of 8% vs 2%, respectively .…”

Section: Introductionmentioning

confidence: 99%

“…5 The combination of diabetes and PAD substantially increases the risk of amputation or non-healing and of cardiovascular mortality. [6][7][8] In the Eurodiale study, patients with a foot ulcer and PAD, when compared with ulcer patients without PAD, had healing rates of 69% vs 84% and major amputation rates of 8% vs 2%, respectively. 2 Not only is PAD an independent risk factor for developing foot ulceration and limb loss, it is also associated with a higher risk of incident cardiovascular disease and of overall mortality, irrespective of symptoms or the populations studied.…”

mentioning

confidence: 99%

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Forsythe

Apelqvist

Boyko

et al. 2020

Diabetes Metabolism Res

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The accurate identification of peripheral artery disease (PAD) in patients with diabetes and foot ulceration is important, in order to inform timely management and to plan intervention including revascularisation. A variety of non‐invasive tests are available to diagnose PAD at the bedside, but there is no consensus as to the most useful test, or the accuracy of these bedside investigations when compared to reference imaging tests such as magnetic resonance angiography, computed tomography angiography, digital subtraction angiography or colour duplex ultrasound. Members of the International Working Group of the Diabetic Foot updated our previous systematic review, to include all eligible studies published between 1980 and 2018. Some 15 380 titles were screened, resulting in 15 eligible studies (comprising 1563 patients, of which >80% in each study had diabetes) that evaluated an index bedside test for PAD against a reference imaging test. The primary endpoints were positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We found that the most commonly evaluated test parameter was ankle brachial index (ABI) <0.9, which may be useful to suggest the presence of PAD (PLR 6.5) but an ABI value between 0.9 and 1.3 does not rule out PAD (NLR 0.31). A toe brachial index >0.75 makes the diagnosis of PAD less likely (NLR 0.14‐0.24), whereas pulse oximetry may be used to suggest the presence of PAD (if toe saturation < 2% lower than finger saturation; PLR 17.23‐30) or render PAD less likely (NLR 0.2‐0.27). We found that the presence of triphasic tibial waveforms has the best performance value for excluding a diagnosis of PAD (NLR 0.09‐0.28), but was evaluated in only two studies. In addition, we found that beside clinical examination (including palpation of foot pulses) cannot reliably exclude PAD (NLR 0.75), as evaluated in one study. Overall, the quality of data is generally poor and there is insufficient evidence to recommend one bedside test over another. While there have been six additional publications in the last 4 years that met our inclusion criteria, more robust evidence is required to achieve consensus on the most useful non‐invasive bedside test to diagnose PAD.

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“…In Germany, researchers have shown a high prevalence and higher risk of PAD among type 1 diabetic elderly patients with a mean age of 62.6 years and in type 2 DM with a mean age of 71.3 years (p < 0.0001), probably related to a longer disease course [40].…”

Section: Dm-related Amputationsmentioning

confidence: 99%

Analysis of Diabetes Mellitus-Related Amputations in the State of Espírito Santo, Brazil

et al. 2020

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Background and objectives: Diabetes mellitus (DM) stands out among the most important public health problems worldwide since it represents a high burden on health systems and is associated with higher hospitalization rates, and a higher incidence of cardiovascular diseases. Amputations are among the most common complications, leading to disability and increasing care costs. This research aims to analyze the prevalence of DM-related amputations, comorbidities and associated risk factors in the diabetic population residing in the State of Espírito Santo, Brazil. Materials and Methods: This is a quantitative, exploratory, cross-sectional study with a time series design and the use of secondary data registered and followed by the system of Registration and Monitoring of Hypertension and Diabetes—SisHiperdia. Results: The sample consisted of 64,196 diabetic patients, out of them, 3.9% had type 1 DM, 10.9% with type 2 DM, and 85.2% with DM coexisting with hypertension. Most were female (66.6%), aged 40 to 59 years (45.6%), and 60 years and older (45.2%). The prevalence of DM-related amputations in the analyzed sample was 1.2% in type 1 DM, 1.5% in type 2 DM, and 2.2% in concomitant DM and hypertension. Higher amputation rates were observed in males in the age group above 60 years in type 1 DM and type 2 DM and were slightly higher in the age groups up to 29 years in DM with hypertension. A higher prevalence of amputation was related to smoking, physical inactivity, acute myocardial infarction (AMI), stroke, chronic kidney disease (CKD), and diabetic foot (DF) in all types of DM. Conclusions: The present study showed a significant prevalence of DM-related amputations. An increased prevalence was evidenced when correlated with smoking, physical inactivity, AMI, stroke, CKD, and DF with significant statistical associations, except for a sedentary lifestyle in type 1 DM.

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Impact of diabetes type on treatment and outcome of patients with peripheral artery disease

Cited by 24 publications

References 16 publications

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Analysis of Diabetes Mellitus-Related Amputations in the State of Espírito Santo, Brazil

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