Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty

Abstract

Diabetes mellitus (DM) is a significant risk factor for loss of patency after endovascular intervention, but the contribution of glycemic control to infrapopliteal artery patency among patients with DM is unknown. All percutaneous infrapopliteal interventions among patients with DM from 2006 to 2013 were reviewed and pre-procedure fasting blood glucose (FBG) was recorded. The primary endpoint was primary patency at 1 year as determined by duplex ultrasound. A total of 309 infrapopliteal lesions in 149 patients with DM were treated with balloon angioplasty during the study period. The median FBG was 144 mg/dL. At 1 year, the rate of primary patency was 16% for patients with FBG above the median, compared to 46% for patients with FBG below the median (hazard ratio (HR) 1.82 for FBG ≥144, p=0.005). Amputation rates at 1 year trended higher among patients with high versus low FBG (24% vs 15%, p=0.1). One year major adverse limb event rates were also higher for patients with high versus low FBG (35% vs 23%, p=0.05). Although patients with high FBG were more likely to have insulin-requiring DM (73% vs 50%, p=0.003) the association of high FBG with loss of primary patency remained significant even after adjusting for insulin use as well as other lesion-specific characteristics (adjusted HR 1.8, 95% CI 1.2–2.8). In conclusion, high fasting blood glucose at the time of infrapopliteal balloon angioplasty is associated with significantly decreased primary patency and may also be a risk factor for major adverse limb events among patients with a threatened limb.

Pharmacological Treatment and Current Management of Peripheral Artery Disease

“…52,53 In addition, observational studies suggest that elevated fasting glucose is associated with lower vessel patency rates and increased rates of adverse limb events in diabetic patients undergoing peripheral angioplasty. 54 Although the data associating diabetes mellitus to future adverse macrovascular events is robust, trials to demonstrate reduction in MACE with glucose lowering therapies have been largely neutral and some have suggested harm with intensive glucose lowering in patients with established cardiovascular disease.…”

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…U chorych na cukrzycę kontrola glikemii jest szczególnie ważna dla poprawy wyników leczenia związanych z kończyną, w tym zmniejszenia częstości dużych amputacji oraz poprawy drożności po rewaskularyzacji poniżej tętnicy podkolanowej [318,319]. Konieczne jest natychmiastowe rozpoczęcie właściwej pielęgnacji ran, a także stosowania odpowiednio dobranego obuwia, leczenia współistniejących zakażeń oraz leczenia bólu.…”

Diabetes mellitus: an important risk factor for peripheral vascular disease

“…stroke, death, MI etc.) but also with higher PAD prevalence among diabetics [27]. In up to 85% of DM related amputations an ischemic foot ulcer precedes [28,29].…”