Glycemia (or, in women, estimated glucose disposal rate) predict lower extremity arterial disease events in type 1 diabetes

Olson, Jon C.; Erbey, John R.; Forrest, Kimberly Y.‐Z.; Williams, Katherine V.; Becker, Dorothy J.; Orchard, Trevor J.

doi:10.1053/meta.2002.30021

Cited by 74 publications

(69 citation statements)

References 34 publications

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“…This proposal is supported by findings from the EDC (34) where estimated glucose disposal rate (a marker for insulin resistance) was prospectively related to lower extremity arterial disease (35). Conflicting results have been reported regarding the relationship between hyperglycemia and CHD in type 1 diabetic cohort studies, with some studies not finding (6,7,36) and other studies finding (28,37) an independent association.…”

Section: Risk Factors For Chd In Type 1 Diabetesmentioning

confidence: 74%

Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe

Soedamah‐Muthu

Chaturvedi²,

Toeller³

et al. 2004

Diabetes Care

223

151

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OBJECTIVE -The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS -Baseline risk factors and CHD at follow-upwere assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD.RESULTS -There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waistto-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD.CONCLUSIONS -This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD. Diabetes Care 27:530 -537, 2004T ype 1 diabetes is associated with a four-(in men) to eightfold (in women) excess risk of coronary heart disease (CHD) (1,2). This substantially elevated risk in women with diabetes effectively obliterates the sex difference in CHD observed in the general population (3,4).Established risk factors do not appear to account for the excess risk of CHD in type 1 diabetes, and reasons for the greater impact in women are not clear. But there is a lack of large prospective studies in type 1 diabetic patients. Much of the research into CHD risk in diabetes has focused on type 2 diabetes and insulin resistance. Type 1 diabetes has a different pathogenesis from type 2 diabetes, and although there are similarities between the diseases such as hyperglycemia, inferences cannot be made from one type to the other for all risk factors, such as lipids and obesity. For example, type 1 diabetes is associated with a favorable lipid pattern compared with the general population, which is clearly not true for type 2 diabetes (5).Previous studies of type 1 diabetic patients suggest that albuminuria (4,6 -9) and raised blood pressure (BP) (4,6 -9) are important risk factors for CHD, but these studies had insufficient power to stratify analyses by sex. The case for an independent relationship between obesity measures and CHD is unclear, the role of the other complications of diabetes uncertain, and findings for lip...

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Section: Risk Factors For Chd In Type 1 Diabetesmentioning

confidence: 74%

Risk Factors for Coronary Heart Disease in Type 1 Diabetic Patients in Europe

Soedamah‐Muthu

Chaturvedi²,

Toeller³

et al. 2004

Diabetes Care

223

151

View full text Add to dashboard Cite

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“…Description of studies Fourteen prospective studies [2,10,12,[20][21][22][23][32][33][34][35][36][37][38] involving 94,640 participants and 1,227 LEA cases were included. Details of study characteristics are provided ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…When a study published more than one paper, we included the publication with the longest follow-up or largest sample size. In order to maximise the available information, we retained three studies [20][21][22] that combined endpoints such as peripheral vascular disease with amputations, assessing the effect of this inclusion through subgroup analysis. We selected 17 studies for inclusion and corresponded with the authors of five [21,[23][24][25][26], of whom two [21,23] provided data, enabling us to calculate relative risks for the 14 studies in this review (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus—review and meta-analysis

et al. 2010

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Aims/hypothesis Diabetes increases the risk of lower extremity amputation (LEA). Although epidemiological studies report positive associations between glycaemia and LEA, the magnitude of the risk is not adequately quantified and clinical trials to date have not provided conclusive evidence about glucose lowering and LEA risk. We synthesised the available prospective epidemiological data on the association between glycaemia measured by HbA 1c and the risk of LEA in individuals with diabetes. Methods We searched electronic databases and reference lists of relevant articles. We considered prospective epidemiological studies that had measured HbA 1c level and assessed LEA as an outcome among diabetic individuals without acute foot ulcerations or previous history of amputation. Of 2,548 citations identified, we included 14 studies comprising 94,640 participants and 1,227 LEA cases. We abstracted data using standardised forms and obtained data from investigators when required. Data included characteristics of study populations, HbA 1c assay methods, outcome and covariates. Study-specific relative risk estimates were pooled using random-effects model meta-analysis; heterogeneity was explored with metaregression analyses. Results The overall RR for LEA was 1.26 (95% CI 1.16-1.36) for each percentage point increase in HbA 1c . There was considerable heterogeneity across studies (I 2 76%, 67-86%; p<0.001), which was not accounted for by recorded study characteristics. The estimated RR was 1.44 (95% CI 1.25-1.65) for type 2 diabetes and 1.18 (95% CI 1.02-1.38) for type 1 diabetes; however, the difference was not statistically significant (p=0.09). We found no strong evidence for publication bias. Conclusions/interpretation There is a substantial increase in risk of LEA associated with glycaemia in individuals with diabetes. In the absence of conclusive evidence from trials, this paper provides further epidemiological support for glucose-lowering as a strategy to reduce amputation in a population without acute foot ulceration or former amputation; it also provides disease modellers with estimates to assess the overall burden of hyperglycaemia.

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“…29 Predictors of all types of PAD include increasing age, male sex, history of foot lesions or ulcers, diastolic BP, low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA 1c ), DM duration, hypertension, albumin excretion rate, glomerular filtration rate (GFR), smoking status, and retinopathy. 10,28,30,31 In a meta-analysis of 5 studies of T1DM patients, with each 1% increase in HbA 1c the risk of PAD increased by 18%. 32 Interestingly, aggressive glycemic control to lower the HbA 1c did not appear to reduce rates of peripheral arterial occlusion in the DCCT/ EDIC study but did reduce the incidence of peripheral arterial calcification.…”

Section: Peripheral Artery Diseasementioning

confidence: 99%