Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease

Abstract

Background: In patients with peripheral artery disease (PAD), the impact of diabetes mellitus (DM) on patient-profile and adverse in-hospital events is not well investigated. Methods: The German nationwide inpatient sample 2005–2019 was used for this analysis. Hospitalized PAD patients were stratified for DM and the influence of DM on patient-profile and adverse in-hospital events was investigated. Results: Our study comprised 2,654,871 hospitalizations (54.3% aged ≥70 years, 36.7% females) of patients with PAD in Germany 2005–2019. Among these, 864,691 (32.6%) patients had DM and 76,716 (2.9%) died during hospitalization. Diabetic PAD patients revealed an aggravated cardiovascular profile (Charlson Comorbidity Index: 6.0 (5.0–8.0) vs. 4.0 (3.0–5.0), p < 0.001). PAD patients with DM showed a higher rate of in-hospital mortality (3.5% vs. 2.6%, p < 0.001), as well as major adverse cardiovascular and cerebrovascular events (MACCE, 4.7% vs. 3.3%, p < 0.001) and had more often operated with amputation surgery (16.4% vs. 9.1%, p < 0.001). DM was an independent predictor of in-hospital mortality (OR 1.077 (95%CI 1.060–1.093), p < 0.001) and MACCE (OR 1.118 (95%CI 1.103–1.133), p < 0.001). In addition, amputations were also associated with DM (OR 1.804 (95%CI 1.790–1.818)), p < 0.001). Conclusions: DM is associated with an unfavorable clinical patient-profile and higher risk for adverse events in PAD patients, including substantially increased in-hospital mortality as well as MACCE rate, and were more often associated with amputation surgeries.

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

“…Patients' main diagnosis is defined as that diagnosis, which is mainly responsible for patients' hospitalization (admission to the hospital). 10 , 14…”

“… 10 , 15 , 16 The Federal Statistical Office of Germany (Statistisches Bundesamt, Wiesbaden, Germany) gathers all data from all inpatient cases in Germany coded and processed according to the DRG system. 10 …”

“…Amputations of the upper extremities and amputations for reasons other than limb ischemia, such as venous ulceration, trauma, and malignancy, were consistently not included in the present analysis. 10 , 21 , 22 …”

“… 9 Moreover, patients with PAD and concomitant DM were shown to have a less favorable clinical profile compared to PAD patients without DM and have consecutively a higher risk for death and morbidity including limb amputation. 10 …”

“… 11 , 12 , 13 Regarding the vast impact of DM on PAD and its negative influence concerning morbidity, amputation, and mortality outcome, patients with diabetes represent a group among PAD patients, which requires special attention regarding treatment care and prevention of disease progress. 10 Owing to the immense efforts of the past years to improve outcome of PAD patients, time trend analyses are of crucial interest to evaluate achieved improvements and to identify ongoing challenges. In the present study, temporal trends of PAD patients with and without DM were analyzed in the German Nationwide Sample investigating all patients who were hospitalized between the years 2005 and 2019 because of PAD in Germany.…”